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)

In an attempt to identify characteristics of tricyclic antidepressant nonresponders, the authors reviewed the records of inpatients with unipolar, nondelusional depression who had received adequate treatment (confirmed by plasma level determination) with tricyclics. The 17 patients who failed to respond were compared to a group of tricyclic responders with respect to demographic and phenomenologic variables. Although the nonresponders tended to have more previous episodes of depression and higher anxiety scores on the pretreatment Hamilton scale than the responders, they could not be distinguished from the responders by clinical or demographic data. All of the patients who failed to respond to tricyclics subsequently responded to monoamine oxidase inhibitors and/or ECT.
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PMID:Tricyclic nonresponders: phenomenology and treatment. 395 69

Twenty-nine patients given unilateral ECT were tested for memory with each treatment. Forgetting of nonverbal material correlated positively with seizure duration and with anesthetic dose. Seizure duration did not correlate with forgetting of verbal material or with changes in Hamilton depression ratings. Seizure duration was inversely related to succinylcholine and methohexital doses. These findings suggest that muscle relaxant and anesthetic doses can be adjusted to lessen the amnestic effects of ECT. There are, however, insufficient data on the relationship between seizure length and ECT efficacy to specify a minimum duration for seizures, individually or cumulatively.
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PMID:Factors affecting amnesia, seizure duration, and efficacy in ECT. 400 87

Twenty psychiatric in-patients were studied before and after five bilateral electroconvulsive treatments for major depression. There were significant memory and neuropsychological changes after treatment, and significant reductions in depression rating scores, but they did not correlate with various measures of blood pressure elevation during treatment. The importance of ECT-related amnesia is discussed.
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PMID:ECT, blood pressure changes and neuropsychological deficit. 406 6

Fifty-one endogenous and reactive female depressives were given a course of either unilateral non-dominant, unilateral dominant, or bilateral ECT. Visual and verbal memory tests and confusion ratings were administered at frequent intervals during the treatment course. Pre-and post-treatment assessments of depression were made. Comparisons of the therapeutic effect of six and of eight ECTs were studied separately. One month after the last ECT the patients were again assessed on the memory and the depression tests. The results of the memory tests indicate that unilateral non-dominant ECT produced least memory disturbance (particularly of a verbal kind) and also less immediate confusion within 40 minutes of each ECT. This observation applies more to the reactive than the endogenous group. Comparisons of the depression tests reveal that unilateral non-dominant ECT is as effective in relieving depression as bilateral ECT, though progress may be less rapid. The observation holds true only for the reactive depressives. Endogenous depressives benefit more from bilateral ECT. Caution is advised against the administration of unilateral dominant ECT, since this group does not respond to treatment as well as the other two groups. Degree of improvement as a whole does not appear to be related to the degree of confusion experienced. The implications of these findings are discussed.
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PMID:Unilateral and bilateral ECT: a study of memory disturbance and relief from depression. 547 54

In a retrospective analysis, the course, symptoms, treatment response, and personality of 54 delusional and 66 nondelusional unipolar depressed patients were compared. The delusional patients had more guilt feelings and were more ruminative, agitated, and referential than the nondelusional patients. They had a poor response to a tricyclic antidepressant therapy but good treatment outcome with a tricyclic-antipsychotic combination or ECT. The form and content of prior episodes were remarkably similar to the index episode in both groups. The authors believe that these findings support the conception of unipolar delusional depression as a distinct subtype of depressive illness.
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PMID:Delusional and nondelusional unipolar depression: further evidence for distinct subtypes. 611 Mar 45

The authors review the use of ECT with nine seriously depressed patients at the National Institute of Mental Health over the past 8 years. Despite the patients' poor prior response to a variety of pharmacological treatments, only one patient failed to show a complete response to ECT. With most patients, improvement was quite rapid and dramatic, and all of the ECT responders were free of depression for at least 1 year after treatment. These results are consistent with previous studies; they deserve reemphasis now in light of recent controversies over ECT, including legislative and judicial attempts to restrict its use.
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PMID:Use of ECT with treatment-resistant depressed patients at the National Institute of Mental Health. 611 Dec 28

Intravenous infusions of clomipramine and maprotiline, preceded by a five-day tranquilising regimen with a neuroleptic drug, were given to 177 patients with treatment-resistant depression. During the treatment period of 10-20 days the patients were given one infusion daily followed by both antidepressants taken orally. The neuroleptic drug was given at night, from the start of the infusion phase to the end of hospitalisation. After four weeks 66% of the endogenous depressions and 53% of the exhaustion depressions had completely regressed. In patients who failed to respond the infusion regimen can be repeated, if necessary with nomifensin (Alival) instead of clomipramine (Anafranil) and maprotiline (Ludiomil) in order to achieve the desired improvement without ECT. In addition to careful diagnosis, a prerequisite for likely success in the management of treatment-resistant depression is the combination of drug administration with adequate psychotherapeutic and physiotherapeutic measures. The infusion regimen is relatively easy to undertake, can also be used on an out-patient basis and could be the treatment of choice in the future, not only for treatment-resistant depressions but also for patients whose depressive state requires rapidly effective antidepressive measures.
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PMID:[Management of treatment-resistant depression without ECT (author's transl)]. 611 26

To investigate the mechanism of action of ECT in depression, functional changes in central noradrenergic systems, resulting from a series of electroshock- or photic-induced seizures have been evaluated in baboons. The plasma growth hormone (GH) response to IV infusion of an alpha 2-noradrenergic agonist clonidine (0.02 mg/kg) or a beta 2-adrenergic antagonist, ICI 118,551 (0.02 mg/kg) has been measured before, during and up to 15 days after the series of seizures. Electroshock (ECS) or sham ECS was given with standard clinical premedication (atropine, methohexital, suxamethonium and oxygen ventilation) seven times over 15 days. Plasma GH responses were unchanged 24 h after one or seven ECS. An enhanced GH response occurred 7 and 15 days after the seventh ECS. Sham ECS (seven times in 15 days) produced no changes in GH response to clonidine. The plasma GH response to ICI 118,551 was apparently decreased 1 and 7 days after the seventh ECS. Photic seizures were induced seven times in 15 days in baboons which were primed with a subconvulsant dose of D,L-allylglycine (180 mg/kg), but were otherwise drug-free. Plasma GH responses to clonidine were enhanced 1 and 7 days after the seventh photically induced seizure. It is concluded that in the primate there is an enhancement of a central alpha 2-noradrenergic response during 1-15 days after a sequence of generalised seizures. The time course of this enhancement appears to be influenced by drugs given directly before the seizures.
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PMID:Changes in noradrenergic neuroendocrine responses following repeated seizures and the mechanism of action of ECT. 612 99

Although ECT is a highly effective treatment for severe depression and other psychiatric syndromes, its mode of action is not known. Recent studies have suggested that effects of ECT on central neurotransmitter receptors may underlie its therapeutic action. The effects of chronically administered electroconvulsive shock on receptors for dopamine, serotonin, noradrenaline, acetylcholine and endorphins in rodent brain, are reviewed. Strategies for evaluating the relevance of these animal findings to mechanisms of action of ECT in humans are discussed.
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PMID:Clinical strategies for evaluating ECT mechanisms--pharmacological, biochemical and psychophysiological approaches. 613 30

Electrocortical and behavioral arousal are separate phenomena subserved by different neural substrata operating in parallel. A comprehensive theory of 'activation' must take into account the relationships between the electrical and behavioral activating systems. In pathological or experimentally induced states paradoxes, resolvable by a theory positing functional interaction between these systems, arise. EEG arousal is directly mediated, in both the waking and sleeping state, by cholinergic mechanisms. Antidepressant withdrawal precipitates cholinergic overdrive; this would account for the apparent disturbances of REM sleep occurring when antidepressants are stopped. Generally, cholinergic overdrive would produce behavioral inhibition but in particular instances it triggers marked psychomotor arousal by mobilizing a 'limbic activating system'. The existence of a monoaminergic 'limbic activating system', system 'A', with the properties attributed to it in this paper, is supported by both clinical and laboratory observations. System 'A' theory provides a parsimonious means of adequately explaining many phenomena. This theory also has in its favor explanatory power and scope. The Cholinergic-Monoaminergic Interaction Theory of antidepressant withdrawal induced activation and of rapidly-cycling manic-depressive illness maintains that system 'A' and a cholinergic inhibitory system interact dynamically, and that excessive monoaminergic function can precipitate excessive cholinergic function and a dearth of monoaminergic function (due to autoregulation) and hence depression. Likewise, excessive cholinergic function is posited to activate monoaminergic systems and hence to secondarily cause behavioral activation. Rapidly-cycling manic-depressive patients, according to the model, develop alternating cholinergic and monoaminergic overdrive states because the homeostatic mechanisms which should serve to maintain, within normal limits, the composite of cholinergic inhibitory and monoaminergic activating influences are defective. Consequently, rather than reaching a reasonable balance compatible with adaptive function there is oscillation between extremes. Each oscillatory movement is actually a move towards the 'golden mean' and is induced by deviation from this ideal but the defective homeostatic mechanisms promote ' perpetual ' overshooting. Lithium and ECT may be useful in the treatment of rapidly-cycling patients as both treatments may down-regulate muscarinic receptors, and otherwise modify cholinergic and monoaminergic systems in ways promoting homeostasis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Antidepressant withdrawal-induced activation (hypomania and mania): mechanism and theoretical significance. 614 95


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