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Biomedical subjects

F M Quitkin

Publications and source records attributed to F M Quitkin.

At least 109 records · Page 6Linked to original sources
PubMed1989

Phenelzine, imipramine, and placebo in borderline patients meeting criteria for atypical depression.

In planning psychopharmacologic treatment of patients with borderline personality disorder (BPD), three partially validated subtypes should be considered. The validity of the schizotypal subtype is supported by their favorable response to neuroleptics as well as by familial and genetic studies. The validity of emotionally unstable character disorder (EUCD) is supported by the presence of neurological soft signs, their negative response to antidepressants, and their positive response to chlorpromazine and lithium. The data presented in this paper suggest that some patients who meet borderline criteria and have atypical depression (patients meeting DSM-III-R criteria for major depression or dysthymia who have reactive mood and any atypical symptoms) clearly benefit from treatment with antidepressant medication. Although some patients with atypical depression who meet borderline criteria will improve with tricyclic therapy, a significantly greater proportion will improve with the monoamine oxidase inhibitor (MAOI), phenelzine.

Borderline Personality Disorder↗
PubMed1988

Antidepressant specificity in atypical depression.

One hundred nineteen patients who met specific criteria for atypical depression completed six weeks of double-blind, randomly assigned treatment with phenelzine sulfate, imipramine hydrochloride, or placebo. The overall response rates were 71% with phenelzine, 50% with imipramine, and 28% with placebo. Phenelzine was widely superior to placebo and also showed superiority to imipramine. Phenelzine superiority appeared even greater after an additional six-week continuation phase. Imipramine was only moderately effective in this atypical depressive sample. Unexpectedly, the superiority of either phenelzine or imipramine to placebo was largely confined to patients in subsets of the study sample who were prospectively judged to also have a history of spontaneous panic attacks and/or show hysteroid dysphoric features. This is consonant with some but not other recent findings and requires replication. Overall, the concept of atypical depression as a subtype that is preferentially responsive to monoamine oxidase inhibitors is supported.

Adolescent↗
PubMed1988

Response of the melatonin cycle to phototherapy for Seasonal Affective Disorder. Short note.

It is well-established that human nocturnal melatonin secretion is suppressed by presentation of artificial light greater than 2,000 lux, a level that is also therapeutically effective in alleviating winter depression symptoms of Seasonal Affective Disorder [SAD]. Furthermore, early-morning bright light induces phase advances of the melatonin cycle in SAD patients (Lewy et al., 1987a). The functional significance of melatonin in SAD remains unclear. With plasma melatonin sampled at 20-min intervals in a series of overnight studies, we found marked phase delays of the cycle, relative to that previously reported for normals, in 4/5 depressed SAD patients. 2,500 lux light exposure at 6-8 a.m. resulted in exponentially declining melatonin levels that approached low daytime baselines within two hours (t1/2 = 45.52 min). All five patients showed clinical remissions as well as phase advances of the melatonin cycle of 0.75 to 3.27 hours (mean, 1.94 +/- 0.84 hours) after one week of daily exposure from 6-8 a.m. and p.m. These results suggest that the combination of early morning and early evening light exposures induces circadian phase adjustments similar to those of morning light alone, by impacting a photosensitive interval when, in SAD, melatonin secretion overshoots its normal nocturnal phase.

Adult↗
PubMed1988

Tyramine sulfate excretion may be a better predictor of antidepressant response than monoamine oxidase activity.

The tyramine sulfate excretion test was performed on 62 nonmelancholic depressed outpatients who then took part in a 6-week double-blind trial comparing imipramine, phenelzine, and placebo. In a double-blind design, nonresponders were switched to one of the active medications. Tyramine sulfate excretion failed to differentiate response from nonresponse to placebo. By contrast, phenelzine responders excreted significantly less tyramine sulfate than did phenelzine nonresponders, while there was a trend in the same direction for imipramine-treated patients. The presence of only eight phenelzine nonresponders dictates caution in interpreting these results. Baseline monoamine oxidase (MAO) activity did not distinguish responders from nonresponders or correlate with tyramine sulfate excretion. Although males had significantly lower MAO activity than females, controlling for sex did not alter these negative findings. These results fail to confirm a previous report of a significant correlation between MAO activity and treatment response in older, mainly melancholic patients.

Adult↗
PubMed1988

Social functioning in chronic depression: effect of 6 weeks of antidepressant treatment.

Social functioning was assessed in 189 nonmelancholically depressed outpatients. Patients were then treated for 6 weeks in a double-blind trial of phenelzine, imipramine, or placebo and functioning was reassessed. Before treatment, younger, more severely depressed, more chronically depressed patients and those with a DSM-III diagnosis of major depression plus dysthymic disorder were more functionally impaired than patients without these characteristics. Chronically depressed patients who responded to treatment reported significantly improved functioning while nonresponders did not. These results suggest that for some chronically depressed patients, impaired functioning results at least partly from the Axis I mood disorder instead of being entirely attributable to Axis II character pathology.

Adult↗
PubMed1988

Lactate provocation of panic attacks in depressed outpatients.

Forty-seven nonmelancholic depressed outpatients were infused with sodium lactate to explore the relationship between history of panic attacks and lactate-induced panic. Lactate panic was rated without knowledge of history of panic. Fifteen of 29 patients (52%) with a history of spontaneous panic experienced panic attacks in response to lactate. Only 1 of 18 patients (6%) without a history of spontaneous panic experienced a lactate-induced panic attack--a highly significant difference. The likelihood of lactate panic was related to frequency of spontaneous panic attacks. The implications of these findings for understanding the relationship of panic attacks and depression are discussed.

Adolescent↗
PubMed1988

Phenelzine versus imipramine in the treatment of probable atypical depression: defining syndrome boundaries of selective MAOI responders.

Sixty patients with probable atypical depression--defined as meeting Research Diagnostic Criteria for depressive illness, having reactive mood, and having one of four associated symptoms (hyperphagia, hypersomnolence, leaden feeling, and sensitivity to rejection)--took part in a study contrasting phenelzine, imipramine, and placebo. Phenelzine was found to be superior to imipramine and placebo. These results were compared to results from a sample of 120 patients with identical characteristics, except that they had more than one associated atypical symptom (full atypical syndrome). The size of the drug effect was comparable in patients with full atypical and partial atypical syndromes.

Adult↗
PubMed1988

Factors associated with premature medication discontinuation among responders to an MAOI or a tricyclic antidepressant.

The charts of 80 outpatients who responded to antidepressants were reviewed to determine if there was a higher rate of premature medication discontinuation with phenelzine than with imipramine. The phenelzine responders had a significantly (p less than .01) higher rate of drug discontinuation, mainly because of side effects. Controlled studies of long-term use are needed to better explain the problem of attrition.

Adolescent↗
PubMed1987

Use of pattern analysis to identify true drug response. A replication.

In any antidepressant study, placebo response in patients assigned active drug is a troubling source of variance. There have been few attempts to identify the patients whose conditions improve as a result of true drug effect, in contrast with improvement that is a result of nonspecific effects. In a previous report we demonstrated that true drug effect seemed to be characterized by a two-week delay in onset and persistence. We described a method of pattern analysis to identify such patients. In this report, we describe the use of pattern analysis to replicate our initial findings. Data from a new sample of 150 nonmelancholic patients support the hypothesis that true drug effect is characterized by a two-week delay in onset and persistence of improvement, once achieved. There was little evidence of the onset of antidepressant effect before two weeks. The theoretical and clinical implications of this work are discussed.

Actuarial Analysis↗
PubMed1987

Baseline characteristics of 10-day placebo washout responders in antidepressant trials.

In antidepressant drug trials, the randomized treatment phase is usually preceded by a single-blind placebo period or "washout." Ninety-four depressed patients who improved during this 10-day placebo period constitute our study focus. Analysis of baseline and postplacebo measures showed that the 10-day placebo responders in our sample were convincingly depressed at baseline and improved significantly after placebo washout. This group of patients differed from 6-week placebo responders in our randomized trials in being more mildly ill, being more chronic, containing fewer cases of primary depression, and having fewer illness precipitants. They differed from placebo nonresponders largely in manifesting milder illness symptoms across the range of psychopathology. The proportion of placebo washout responders declined in the winter months.

Adolescent↗
PubMed1987

A comparative study of the electrocardiographic effects of phenelzine, tricyclic antidepressants, mianserin, and placebo.

Although the electrocardiographic effects of the tricyclic antidepressants have been extensively investigated, there are fewer data on the effects of monoamine oxidase inhibitors and tetracyclics on cardiac conduction. This study used high speed recordings of the electrocardiogram to investigate the cardiographic effects of phenelzine and mianserin and to compare these to the effects of imipramine, amitriptyline, and placebo. Phenelzine caused significant slowing of the heart rate, while mianserin showed little effect on heart rate compared to the increases in rate seen with tricyclics. In clinically effective doses, neither phenelzine nor mianserin caused changes in conduction, while both tricyclics studied caused the expected prolongation of conduction. These data suggest that phenelzine and mianserin deserve further study in patients with disease of the cardiac system as they may be less likely to cause heart block in these patients.

Adult↗
PubMed1986

Study duration in antidepressant research: advantages of a 12-week trial.

There has been an increasing interest in studying the effectiveness of antidepressants in non-melancholic depressives. For non-melancholic patients who are characterized by transient mood improvement, a single cross-sectional evaluation may reflect temporary change. Transient improvement, like any source of instability in an outcome measure, reduces validity and consequently power. To minimize the effects of transient mood change in non-melancholic depressives, we designed a two-phase drug trial. The first phase was a standard 6-week trial. Those judged responders at the end of the first phase entered the second 6-week phase. Between weeks 6 and 12 it was anticipated that a smaller proportion of six-week responders would relapse on drug than placebo, thus sharpening the contrast between treatments. The purpose of this paper is to demonstrate the power advantages of the 12-week design. Data is presented which suggests that a 12-week design reduces transient improvement, increases treatment effect size, and requires a smaller number of patients for equivalent statistical power. It also offers a better estimate than a 6-week study of the proportion of patients who will have persistent clinical benefit.

Adolescent↗
PubMed1986

How blind is blind? Assessment of patient and doctor medication guesses in a placebo-controlled trial of imipramine and phenelzine.

The purpose of the double blind is to protect the internal validity of a clinical trial by preventing knowledge of treatment conditions from influencing outcome or its assessment. We studied medication guesses of 137 depressed patients and/or their doctors at the end of a 6-week randomized trial of placebo, imipramine, and phenelzine. Overall, 78% of the patients and 87% of the doctors correctly distinguished between placebo and active medication. Clinical outcome, treatment condition, and their interaction each contributed to guessing accuracy, while medication experience and side effects assessed only in week 6 did not. Accuracy was high, however, even when cases were stratified for clinical outcome, indicating that other cues were available to the patients and doctors. These may include patterns and timing of side effects and clinical response not detectable in this end-point analysis.

Adolescent↗