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Biomedical subjects

A J Levitt

Publications and source records attributed to A J Levitt.

At least 19 recordsLinked to original sources
PubMed1998

Impact of suppression of thyroxine on folate status during acute antidepressant therapy.

Antidepressant response is associated with a rise in red cell folate (RCF) and a reduction in thyroxine (T4). Since T4 levels may directly influence folate status, it is possible that the increase in folate with recovery results from the decline in T4. To examine the possible role of thyroid hormones in the observed change in folate status during antidepressant therapy, T4, tri-iodothyronine (T3) or placebo was given in a double-blind fashion to 25 depressed subjects at the initiation of standard antidepressant treatment. Folate levels and mood [using the Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI)] were measured at baseline and following 4 weeks of therapy. Using MANOVA for repeated measures, there was a significant interaction between response status and time for vitamin and hormone levels. Univariate analysis confirmed that response was associated with a significant change in red cell folate, but not a significant change in T4 or T3. The mean change in RCF across the 4-week trial was significantly greater in the 14 responders than the 11 non-responders. Change in RCF, and not change in T4 or T3, was significantly correlated with change in HAMD and contributed significantly to the variance in change in HAMD. These results suggest that change in RCF is closely tied to response to antidepressant treatment, and this effect is not inhibited by exogenous administration of thyroid hormones or the changes in T4 that the exogenous hormones produce. These findings support the possible role of folate, independent of thyroid function, in the modulation of mood.

Adult↗
PubMed1998

Hormonal and subjective responses to intravenous m-chlorophenylpiperazine in women with seasonal affective disorder.

BACKGROUND: There is emerging evidence of serotonergic dysfunction in patients with seasonal affective disorder (SAD). We examined central serotonergic function in female patients with SAD (fall-winter pattern) by means of neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist m-chlorophenylpiperazine. METHODS: Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to m-chlorophenylpiperazine (0.1 mg/kg intravenously) and placebo in 14 unmedicated female patients with SAD in the depressed state and 15 female normal controls. All testing was done in the fall-winter months and during the follicular phase of the menstrual cycle. Plasma prolactin and cortisol levels were used as neuroendocrine measures, while subjective responses were assessed by means of visual analog scales of 10 mood states. RESULTS: On the basis of net responses to m-chlorophenylpiperazine (placebo effects subtracted from drug effects), patients with SAD exhibited blunted prolactin responses and less sadness than normal controls in response to the drug. When order of presentation of drug and placebo was taken into consideration, altered "calm" and "high" responses were also found in the patient group. CONCLUSION: Evidence of dysfunction at or downstream to central serotonergic receptors in female patients with SAD confirms and extends findings from previous research.

Adult↗
PubMed1998

Does the chronological relationship between the onset of dysthymia and major depression influence subsequent response to antidepressants?

OBJECTIVE: To determine whether the chronological relationship between the onset of dysthymia and the onset of the first major depression influences treatment outcome in patients with double depression (DD). METHOD: Clinical and outcome measures previously collected in 77 consecutive outpatients who presented with major depression and who had pre-existing dysthymia (i.e. DD) were reviewed for the current retrospective analysis. Subjects had been administered the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-LV), and the Hamilton Rating Scale for Depression (HAM-D) prior to open antidepressant treatment and after 5 and 12 weeks of therapy. Response was defined as a 50% decline in HAM-D to score +/-8. Subjects were divided into those with the onset of dysthymia before the first major depression (DysB; n = 47), onset of dysthymia after major depression (DysA; n = 12) and those with onset of both condition within 2 years of each other (INDIST; n = 18). RESULTS: There were no significant differences between these three groups in baseline HAM-D. However, DysA subjects had significantly higher mean HAM-D scores than the DysB subjects at week 5 and the INDIST subjects at week 12. Response rates at week 12 were lower in subjects with DysA (33%) as compared with DysB (57%; Fisher's exact test, P = 0.06) and INDIST (78%; Fisher's Exact test P = 0.02). CONCLUSIONS: These findings suggest that the onset of the first episode of dysthymia after the first major depressive episode (i.e. DysA) may adversely affect response to subsequent treatments in patients with DD.

Adolescent↗
PubMed1997

Thyroid hormone levels before unsuccessful antidepressant therapy are associated with later response to T3 augmentation.

Thyroid function was measured in 24 patients before antidepressant treatment, and following failure of acute desipramine treatment but before triiodothyronine (T3) augmentation. While all measures of thyroid function were within the euthyroid range, eventual T3 augmentation responders were found to have, prior to any antidepressant treatment, lower levels of TSH and higher levels of thyroxine (T4) and free thyroxine index (FTI) than non-responders. This suggests that T3 augmentation may be of particular importance in subjects with comparatively elevated levels of serum FTI.

Adult↗
PubMed1997

Hormonal and subjective responses to intravenous meta-chlorophenylpiperazine in bulimia nervosa.

BACKGROUND: Several lines of evidence point to serotonergic abnormalities in patients with bulimia nervosa (BN). Our goal was to further examine central serotonergic function in bulimic patients using neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist meta-chlorophenylpiperazine (mCPP). METHOD: Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to intravenous mCPP (0.1 mg/kg) and placebo in 16 patients with BN, free of medication, and 14 normal control subjects. Plasma prolactin and cortisol levels were used as neuroendocrine measures, whereas subjective responses were measured using a visual analog scale of 10 different mood states. RESULTS: Compared with controls, the BN group exhibited blunted prolactin and net cortisol responses following mCPP challenge. Subjective responses, while preliminary, also differed between groups on items related to anxiety, calmness, and altered self-awareness. CONCLUSION: Evidence of dysfunction at or downstream of central serotonergic receptors in BN confirms and extends findings of prior research.

Adolescent↗
PubMed1996

Bipolar disorder, unipolar depression and the Five-Factor Model of personality.

We examined differences between personality characteristics of euthymic bipolar disorder patients (BD) (n = 34) and recovered unipolar depressed patients (UD) (n = 74) using the taxonomy of the Five-Factor Model of personality (FFM) as measured by composite scales derived from the NEO Personality Inventory (NEO PI) and the revised NEO PI (NEO PI-R). Euthymic BD patients scored significantly higher on the Openness (O) dimension and the Positive Emotions facet of the E dimension than did recovered UD patients. For O, euthymic BD patients scored higher on the Feelings facet. These results suggest not only that euthymic BD patients are more likely to experience positive affects than recovered UD patients, but also that euthymic BD patients are more receptive to their positive and negative feelings than are recovered UD patients.

Adult↗
PubMed1996

Seasonal and non-seasonal depression and the five-factor model of personality.

The purpose of this study was to compare the personality characteristics of patients with non-psychotic, major depression, seasonal subtype (SAD) to patients with non-psychotic, major depression, without seasonality (non-SAD). The patients were consecutive referrals to a university-affiliated mood disorders outpatient clinic. The personality characteristics were assessed using the five-factor model of personality (FFM) as measured by the revised NEO Personality Inventory (NEO PI-R). Patients were assessed during the acute depressive episode. Controlling for severity of depression, differences were found on only one of the five dimensions, with the SAD patients (n = 43) scoring significantly higher on the Openness dimension than non-SAD patients (n = 57). Based on these results we infer SAD patients may represent a psychologically distinct subgroup of depressed patients-more imaginative, more emotionally sensitive and likely to entertain unconventional ideas than non-SAD patients. This personality constellation may explain why individuals with SAD are more sensitive to and may amplify the mild dysphoria typically associated with winter months.

Depressive Disorder↗
PubMed1996

Serum Mg2+ and Ca2+/Mg2+ ratio in major depressive disorder.

Serum Mg2+ has been implicated in the symptom severity and pathophysiology of mood disorders. Furthermore, the recent findings of blunted signalling through the G-protein-coupled adenylyl cyclase (AC) pathway in major depressive disorder (MDD) and the importance of Mg2+ in G-protein/AC function led us to reexamine in a large sample whether serum Mg2+ concentrations were decreased in MDD patients. In 145 drug-free MDD patients compared with 2 control groups: (a) patients with bipolar disorder (n = 33) and (b) non-mood-disordered patients (n = 47), there were no differences in Mg2+ levels or Ca2+/Mg2+ ratios. Neither of these measures differed when comparing responders and nonresponders to antidepressant treatment.

Adult↗
PubMed1996

A controlled comparison of light box and head-mounted units in the treatment of seasonal depression.

BACKGROUND: Patterns of response to the light box and head-mounted unit (HMUs) in seasonal affective disorder (SAD) appear to differ. The current study employed a "no light" condition to compare the response rates with the light box and HMU against a plausible placebo. METHOD: Forty-three subjects with DSM-III-R nonpsychotic, unipolar major depression, seasonal subtype, were randomly assigned, in a double-blind manner, to receive 2 weeks of active treatment with a light box (N=9) or HMU (N=12) that emitted no visible light, or 2 weeks of placebo treatment with a light box (N=12) or HMU (N=10) that emitted no visible light. Response was defined as a 50% or greater reduction in both the 17-item "typical" score and 8-item "atypical" score on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD version (SIGH-SAD). RESULTS: Using ANOVA for repeated measures, with change in total SIGH-SAD score as the dependent measure, we found no significant main effect of light (F=0.20, p=N.S.) or unit (F=0.50, p=N.S.), and no interaction (F=0.21, p=N.S.). Using log-linear analysis, we found no significant difference in response rate between the four cells (likelihood ratio chi-square = 2.1, p=N.S.). Using chi-square analysis, we found no significant difference in response rates between patients who received light (48%) versus patients who received no light (41%; chi-square = 0.2, p=N.S.) or between patients who received the light box (38%) versus HMU (50%; chi-square = 0.62, p=N.S.). CONCLUSION: The failure to detect any significant difference in efficacy between active and placebo treatments calls into question the specificity of light in light therapy for SAD. Methodological limitations, particularly small sample size, are discussed.

Adult↗
PubMed1996

Response to an open trial of a second SSRI in major depression.

BACKGROUND: We evaluated the efficacy of a second serotonin selective reuptake inhibitor (SSRI) in patients who had failed to respond to the first SSRI used. METHOD: Fifty-five patients with major depression who had failed one of the SSRIs for their current depressive episode were included. After failing a trial of one SSRI, they received a second SSRI in an open clinical trial. RESULTS: On the basis of the Clinical Global Impression-Improvement scale, 28 of 55 patients had a marked or complete antidepressant response. CONCLUSION: These data provide preliminary clinical evidence that substituting a second SRI may be a useful clinical alternative in depressed patients who fail to respond to an adequate trial of an SSRI.

1-Naphthylamine↗
PubMed1996

Augmentation strategies: focus on anxiolytics.

Approximately 20% to 40% of patients will fail to respond to the first antidepressant used for their current major depressive episode. Furthermore, it has been suggested that a further 20% to 30% of patients will have only a partial response. There are four main options to consider in the treatment of these patients: optimization, substitution, augmentation, and combination therapy. Several combination antidepressant treatments have been used in treatment-refractory depression. Moreover, various augmentation strategies have also proved to be successful. Although the empirical data to support these treatment options are limited, augmentation treatment has several potential advantages over the other clinical options available, particularly substitution. These data are reviewed and clinical applications discussed. Particular attention is paid to the role of anxiolytics as augmentation agents in the treatment of major depression.

Anti-Anxiety Agents↗
PubMed1995

A comparison of Tridimensional Personality Questionnaire dimensions in bipolar disorder and unipolar depression.

The harm avoidance (HA) personality dimension has been hypothesized to be a vulnerability factor for unipolar depression (UD) but not for bipolar disorder (BD). The reported difference on HA scores between these diagnostic groups may have been compromised by the assessment of BD patients who had not fully recovered. To test the diagnostic specificity of elevated HA scores and to elucidate whether assumptions about differences between patients with UD or BD might be attributed to the lingering effects of mood state, the Tridimensional Personality Questionnaire (TPQ) was administered to recovered patients with either BD or UD and a nonpatient comparison group. Both patient groups scored higher on the HA dimension than the nonpatient comparison group, but the patient groups did not differ from one another on this dimension. Moreover, novelty seeking (NS) scores were elevated in subjects with BD compared with both UD patients and nonpatient subjects. These results suggest that high HA scores may be associated with a mood disorder diagnosis, whereas high NS scores may be associated with the BD subtype.

Adult↗
PubMed1995

Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder.

OBJECTIVE: The authors investigated the efficacy and safety of fluoxetine in the treatment of winter seasonal affective disorder. METHOD: Sixty-eight outpatients who met the DSM-III-R criteria for recurrent major depressive episodes, seasonal (winter) pattern, were randomly assigned to 5 weeks of treatment with fluoxetine, 20 mg/day (N = 36), or placebo (N = 32). The outcome measures included the 29-item modified Hamilton Depression Rating Scale, administered by experienced clinicians, and the self-rated Beck Depression Inventory; adverse events and safety data were also recorded. Clinical response was defined as a greater than 50% reduction in depression score between baseline and study termination. RESULTS: Both groups showed significant improvement. The fluoxetine group had lower depression scores at termination than the placebo group, but these differences did not achieve statistical significance. However, the rate of clinical response in the fluoxetine group (59%) was superior to that in the placebo group (34%). Post hoc analyses showed that the greatest fluoxetine responses were in the most markedly depressed patients and that overall response was greater for patients studied later in the season. Fluoxetine was well tolerated, and few subjects dropped out because of adverse events. CONCLUSIONS: On the basis of clinical response rate, fluoxetine appears to be an effective, well-tolerated treatment for seasonal affective disorder. Because the differences between fluoxetine and placebo in the continuous outcome measures did not reach statistical significance, further studies with larger study groups and longer treatment periods are required to conclusively demonstrate efficacy of fluoxetine for seasonal affective disorder.

Adult↗
PubMed1995

Treatment of seasonal affective disorder: a review.

OBJECTIVE: To review the status of current treatment of seasonal affective disorder (SAD). METHOD: Treatment studies of SAD published between January 1989 and March 1995 were identified using a computerized MEDLINE literature search. Additional citations were obtained from the reference sections of these articles. Studies included in this review were selected using operational methodologic criteria. RESULTS: Many studies support the efficacy of bright light therapy using a fluorescent light box. The best studied protocol is > 2500 lux white light for 2 hours per day, but newer protocols using 10,000 lux for 30 minutes have comparable response rates. Studies of light visors and other head-mounted devices also report similar response rates, but have not yet shown superiority over putative control conditions. There are fewer medication studies in SAD, but controlled studies suggest that fluoxetine, d-fenfluramine and propranolol are effective. Other treatments such as dawn simulation require further study. No studies of psychological treatments for SAD were found. Many studies had methodologic limitations, including brief treatment periods, small sample sizes, and lack of replication, that limit the generalizability of findings. CONCLUSION: There are several well-studied, effective treatments for SAD, including light therapy and medications. However, further research must be done to demonstrate sustained treatment response over time, to clarify the intensity-response relationship of light therapy, to clarify the role of light therapy and medications, and to assess combination treatments.

Humans↗