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

We analyzed the type and dosage of opiates used for pain in a large general hospital from April to September 1985. Information was obtained from the computerized data base in 234 patients with a mean age of 49 years. Most patients came from the surgical service. The route of administration was intramuscular in 64% and not specified in 10% of patients. The most common drug was meperidine, the dose being 65 +/- 26 mg intramuscular and 39 +/- 26 intravenously. Methadone and morphine were used with less frequency. Good analgesic effect was recorded in 42 of 71 (59%) of patients, but the effect was not written down in the majority of subjects (70%). Other analgesics were associated in 73% of cases, most commonly a pyrazolone derivative. Nausea or vomiting was observed in only 12 patients; there were no instances of respiratory depression. We conclude that the dose of opiate used was frequently low and the associated drugs were not the best to obtain increased analgesic effect. Better recording of clinical effect of analgesics is needed in medical practice.
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PMID:[The use of opiates in hospital practice]. 274 38

Human subjects submitted to treatment with morphine show a severe depression of phagocytosis, killing properties and superoxide production both of their polymorphonuclear leukocytes and monocytes. Polymorphonuclear leukocyte adherence, chemotaxis, random migration, myeloperoxidase content, lysozyme content and lymphocyte Rosette E formation were poorly influenced. Methadone-treated subjects show a similar effect at phagocytic level but far less evident. These results confirm those previously found in animals and reinforce the evidence of a depressive role of morphine on phagocytic physiology.
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PMID:Morphine and methadone impact on human phagocytic physiology. 300 Sep 61

The effects of ascending and descending doses of buprenorphine (0.014-0.789 mg/kg/day) and methadone (0.179-11.86 mg/kg/day) on opiate and food intake were studied in Macaque monkeys over 195 to 245 days. Food (1-g banana pellets) and i.v. drug self-administration (heroin 0.01 or 0.02 mg/kg/injection or Dilaudid 0.02 mg/kg/injection) were maintained on a second-order schedule of reinforcement [FR 4 (VR 16:S)]. Buprenorphine (0.282-0.789 mg/kg/day) produced a significant suppression of opiate self-administration at 2.5 to 7 times the dose shown to be effective in human opiate abusers (P less than .05-.001). Methadone (1.43-11.86 mg/kg/day) did not suppress opiate self-administration in four of five monkeys across a dose range equivalent to 100 to 800 mg/day in man. The distribution of opiate self-administration across drug sessions did not account for the absence of methadone suppression as monkeys took 43% of the total daily opiate injections during the first daily drug session, 2.5 hr after methadone administration. During buprenorphine maintenance, food intake remained stable or increased significantly above base-line levels. Methadone maintenance was associated with significant decrements in food intake in four of five monkeys. Buprenorphine appeared to be significantly more effective in suppressing opiate self-administration than methadone across the dose range studied. Buprenorphine had none of the toxic side effects (seizures, respiratory depression, profound psychomotor retardation) associated with high doses of methadone over 6 to 8 months of daily drug treatment. These data are consistent with clinical studies of buprenorphine effects on heroin self-administration in human opiate addicts.
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PMID:Comparison of buprenorphine and methadone effects on opiate self-administration in primates. 618 22

The effects of oral methadone on respiration, ventilation, pupillary diameter, and plasma concentrations of estrone, estradiol, and progesterone were investigated in healthy nonpregnant women, 21 to 29 yr old. All women were in the follicular phase of the menstrual cycle. The study design was a randomized, double-blind, placebo-controlled trial. Six women received 15 mg methadone . HCl, and six received placebo. Alveolar ventilation and oxygen consumption before treatments correlated with plasma progesterone concentration (r2 = 0.85 and 0.68) but the slope and x-intercept of the ventilatory response to carbon dioxide curve did not. Female sex steroids in plasma were not affected by methadone. Mean elimination half-life of methadone from serum was 19 hr. Methadone-induced respiratory depression and miosis lasted more than 48 hr. The intensity of these changes was a linear function of the logarithm of the serum methadone concentration. Plasma progesterone concentration is an important determinant of resting ventilation and metabolism in the follicular phase of the menstrual cycle but endogenous progesterone does not protect women from the respiratory depressant effects of methadone.
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PMID:Respiratory and ventilatory effects of methadone in healthy women. 678 8

Prolactin concentrations of 30 unmedicated psychiatric inpatients and 11 normal controls were measured at baseline and at 30 and 60 minutes after the administration of 10 mg of intramuscular methadone hydrochloride. Methadone raised the prolactin level at 60 minutes to more than twice the mean baseline level for the full subject sample. Patients with depressive disorders had lower mean basal prolactin levels than did the other subjects, and also manifested attenuated prolactin responses to methadone. Eight of 16 depressives had markedly blunted prolactin responses, a finding consistent with other studies reporting deficient responses in depression. These data are consistent with the hypothesis that the pathophysiology of depressive disorders involves dysfunctions in the anterior pituitary itself or in the hypothalamic neurotransmitter and neuromodulator systems (eg, endorphins) that regulate the secretion of prolactin and other neurohormones.
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PMID:Blunted prolactin response. A neuroendocrine abnormality manifested by depressed patients. 714 2

Methadone is a synthetic opioid with excellent oral bioavailability, variable, but long duration of action and extremely low cost. Our group has found that methadone is well tolerated in patients with difficult pain syndromes who are receiving high dose opioids. However, because of high interpersonal variation in bioavailability and the long duration of action of this drug, treatments should be highly personalized. We report on a 61 year old cancer patient who was switched from 84 mg/day of subcutaneous hydromorphone to 90 mg/day of oral methadone. On this dose, she developed respiratory depression and non-cardiogenic pulmonary edema that responded to subcutaneous naloxone and methadone discontinuation. Our findings suggest that standard equalanalgesic tables are unreliable for methadone titration. Switchovers should take place slowly and in a personalized fashion.
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PMID:Respiratory depression in a patient receiving oral methadone for cancer pain. 767 74

Methadone maintenance patients (N = 217) were administered a computerized screening version of the National Institute for Mental Health (NIMH) Diagnostic Interview Schedule (DIS), the Beck Depression Inventory (BDI) and the Addiction Severity Index (ASI) 2-4 weeks after treatment entry. Few differences were found between African-American, Hispanic, and Caucasian subjects. Only 1.7% of the patients met a lifetime diagnosis of major depressive disorder, and 1.4% qualified for a current diagnosis major depressive disorder. In contrast, 35.8% of the patients reported moderate to serious depression on the BDI during the previous week, and 19.3% reported serious depression during the previous month on the ASI (38.7% lifetime depression). Because moderate correlations were found between the DIS, the BDI, and the ASI measures of depression, there is some indication that they were tapping a similar construct. Therefore the lower rates of depression found with the DIS are probably attributable to its more stringent definition of depression. The findings tend to confirm previous literature indicating that the DIS, as contrasted with other structured psychiatric interviews, underestimates depression.
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PMID:Conflicting measurements of depression in a substance abuse population. 832 85

Alcoholism is a prevalent problem encountered during the methadone treatment of opioid dependence. The unique feature of examining alcoholism in methadone clinics is the ability to objectively measure alcohol consumption on a frequent basis. The present study examined how blood alcohol level (BAL) relates to clinic absenteeism and whether any paper and pencil tests predict BAL in alcoholic methadone patients. Thirty-eight alcoholic methadone patients receiving outpatient treatment had their BALs assessed over consecutive 5-day periods for a period of 2 months. The relationship of these BALs to several measures, including the Michigan Alcohol Screening Test (MAST), Beck Depression Inventory (BDI), clinic absenteeism and methadone dose was assessed. Significant positive correlations between mean BAL and admission MAST, mean BAL and clinic absenteeism, and MAST and BDI were observed. Methadone dose tended to be inversely correlated with mean BAL. These findings demonstrate that the MAST predicts mean BAL and that mean BAL is an objective predictor of clinic absenteeism in alcoholic methadone patients. Moreover, the results illustrate the usefulness of methadone clinics as a setting to investigate alcohol abuse and dependence.
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PMID:The relationship of mean daily blood alcohol levels to admission MAST, clinic absenteeism and depression in alcoholic methadone patients. 838 89

This article reports on the HIV risk behaviors of a sample of 158 women heroin addicts admitted into the Los Angeles Enhanced Methadone Maintenance Project. Risk behaviors for HIV were associated with age, lack of education, ethnicity, relationship with a drug user, HIV status, and higher scores on measures of illegal activity, suicidality, depression, polydrug use, and alcohol use. Significant reductions in number of male sex partners and needle-sharing partners were reported at follow-up, although frequency of condom use was unchanged. Methadone maintenance programs need to screen women for risk factors and assist them in developing new behavioral skills in order to implement a harm reduction approach to treatment.
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PMID:HIV risk behaviors among women in methadone maintenance treatment. 883 63

This study tested the effectiveness of fluoxetine as a treatment for depression in a population of methadone-maintained opioid addicts. Methadone-maintained opioid addicts (44) with depression received fluoxetine or placebo in addition to their methadone, in a double-blind randomized trial, for 12 weeks. Depressive symptoms decreased significantly overall with no significant differences between the groups treated with fluoxetine versus placebo. In addition, drug use outcomes, including cocaine and heroin self-reported use and urine toxicology were measured. There was a significant decrease in heroin use in treatment, but no medication effect. Cocaine use, was unchanged from pre-treatment to endpoint. In separately analyzing data for the subsample of subjects with the most severe depression, there was a significant decrease in depression during treatment and a significant decrease in self-reported cocaine use, but no medication effect on either depressive symptoms or on cocaine use. This study suggests that fluoxetine is not an effective agent in treating depression or cocaine use in this population.
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PMID:Fluoxetine treatment of depressive disorders in methadone-maintained opioid addicts. 964 75


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