Biomedical subjects

Alan J Gelenberg

Publications and source records attributed to Alan J Gelenberg.

24 records · Page 2Linked to original sources

PubMed2002

Depression, antidepressant therapies, and erectile dysfunction: clinical trials of sildenafil citrate (Viagra) in treated and untreated patients with depression.

Erectile dysfunction (ED) and depression are highly prevalent conditions and frequently occur concomitantly in predisposed individuals. Men with ED and depression are also likely to have other comorbid conditions, including diabetes, hypertension, and heart disease. Because ED is also a common adverse effect of some medications for these conditions, patients are frequently noncompliant with treatment. Sildenafil citrate (Viagra) is effective in treating ED of a broad range of etiologies, suggesting that it may be equally beneficial in patients with ED that is associated with depressive symptoms and in those with ED resulting from serotonergic reuptake inhibitor (SRI) antidepressant treatment. We review the results of 3 randomized, placebo-controlled trials and a retrospective analysis of data pooled from 10 clinical trials that examine the efficacy of sildenafil in treating ED associated with depression and as an adverse effect of SRI treatment. The results suggest that sildenafil is efficacious as a first-line treatment for ED in men with untreated minor depression, in men with ED that is refractory to successful SRI treatment of depression, and in those whose depression was successfully treated but who developed ED as a consequence of SRI treatment. Given the complex interrelations among ED, depression, and other comorbid conditions, the key to proper management is a comprehensive evaluation, including sexual function, and an accurate differential diagnosis.

Antidepressive Agents, Second-Generation↗

PubMed2002

Sequential catecholamine and serotonin depletion in mirtazapine-treated depressed patients.

This study was aimed at determining whether patient- or antidepressant-related variables are most important to the mood response to serotonin (5-HT) or catecholamine depletion. Depressed patients treated with open-label mirtazapine (>or=6 wk) received two depletion tests (5-HT and catecholamine depletion) 1 wk apart. Both 5-HT and catecholamine depletion led to a partial return of depression in most patients. Antidepressant response to mirtazapine is dependent on its dual actions on norepinephrine and 5-HT neurotransmission. Mood response to tryptophan or catecholamine depletion is dependent on the pharmacological properties of the antidepressant being taken during depletion.

Adrenergic Uptake Inhibitors↗

PubMed2002

Sexual function and satisfaction in the treatment of chronic major depression with nefazodone, psychotherapy, and their combination.

BACKGROUND: Changes in sexual interest/satisfaction and function are frequently associated with major depression and the use of some antidepressant treatments. This study compares the effects of antidepressant medication, psychotherapy, and combined treatment on sexual interest/satisfaction and function in patients with chronic major depression. METHOD: Outpatients with chronic forms of DSM-IV major depressive disorder (N = 681) were randomly assigned to 12 weeks of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or combined nefazodone/CBASP. The Modified Rush Sexual Inventory was used to assess sexual functioning, and the 24-item Hamilton Rating Scale for Depression was used to assess depressive symptoms. RESULTS: At baseline, 65% of men and 48% of women reported some sexual dysfunction. Statistically significant linear improvement in sexual interest/satisfaction was noted across all 3 treatment groups (p < .001). Additionally, significant improvement in sexual function was observed across all 3 treatment groups on a composite measure of female sexual function (p < .001). Controlling for depressive symptoms and gender, combined treatment produced greater improvement in total sexual interest/satisfaction than CBASP alone (p = .007), but was not significantly different from nefazodone alone. Improvement in depressive symptoms was associated with improved sexual interest/satisfaction for men and women and, for men, improved sexual functioning. CONCLUSION: Chronic depression is associated with high rates of sexual dysfunction. Treatment with nefazodone, CBASP, and combined treatment improved sexual interest/satisfaction, with greatest improvement observed with combined treatment.

Adult↗

PubMedDate not supplied

Matching the bipolar patient and the mood stabilizer.

Bipolar disorder poses many treatment challenges, including "matching" a particular patient with the optimal treatment regimen. Although there are a number of extant guidelines to assist the clinician in selecting treatment, these recommendations are largely based on general variables and fail to take into account the subtleties and complications that confront a clinician in practice. An analysis of predictors of medication response in bipolar disorder provides a basis for matching patients with optimal medication regimens. Response to treatment may depend on the polarity of an episode or on clinical features such as mixed or psychotic symptomatology and rate of cycling. Comorbid psychiatric disorders such as substance abuse, anxiety disorders, or attention-deficit/hyperactivity disorder should also be considered in designing a treatment regimen. Similarly, medical conditions, especially metabolic abnormalities or kidney insufficiency, must be taken into account. Selection of medication may also involve an analysis of demographic factors, including family and personal history of response to a particular agent. When selecting the most appropriate mood stabilizer for a patient--particularly when polypharmacy is required--the clinician should keep potential side effects and drug interactions in mind. Randomized, controlled studies in bipolar populations are needed to further characterize optimal matching of patient and medication.

Anticonvulsants↗

PubMedDate not supplied

Health outcomes for people with serious mental illness: a case study.

PURPOSE: To describe outcomes of clients with serious mental illnesses who used regional public mental health services; and what the public mental health system did well or needed to change to better satisfy clients' needs. METHODS: A modal case study analysis method was used with 15 clients. Participants were interviewed three times. FINDINGS: Participants reported dissatisfaction with their social functioning and general health, and unmet needs for case management services, social/recreational activities, and vocational rehabilitation. CONCLUSIONS: The case study method is an effective way for nurses to evaluate public mental health systems and to determine areas for system intervention.

Adult↗

PubMedDate not supplied

Consultative intervention to improve outcomes of high utilizers in a public mental health system.

PURPOSE: To examine the effectiveness of an academic consultation on outcomes among consumers in a public mental health system and to compare outcomes between high-cost/high-utilizer and midcost consumers. METHODS: Participants (N = 36) completed all questionnaires during three semistructured interviews. Using a repeated-measures experimental design, the outcomes of global functioning, quality of life, service use and need, costs, and consumer satisfaction were examined. FINDINGS: The hypothesis that consultation would change medication practices and reduce costs was supported. CONCLUSIONS: Consultation with a senior clinician helped change medication practices and reduced costs. Consultation may lead to recognition of a new diagnosis (medical, neurologic, or psychiatric) or suggestions for modifying a treatment regimen that could improve functioning and QOL. In a busy public mental health system, there is often little time for consultation and little thought to second opinions. For clients who cost the system the greatest amount, the small additional cost of a consultation is a good potential investment.

Adult↗