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Biomedical subjects

J F Greden

Publications and source records attributed to J F Greden.

At least 91 records · Page 5Linked to original sources
PubMed1987

Imipramine and tinnitus.

Although tinnitus is listed among the rare neurologic side effects of tricyclic antidepressants, little is known about its prevalence, mechanism of development, course, and management. A chart review of 475 patients treated with tricyclic antidepressants indicated that tinnitus occurred in about 1% of the patients. The case vignettes of 5 patients who developed tinnitus in the course of imipramine therapy are presented. Each developed tinnitus in the second or third week of treatment with imipramine at daily dosages of 150-250 mg and at combined plasma imipramine-desipramine levels between 200-450 ng/ml. In each patient, tinnitus subsided spontaneously within 2-4 weeks of onset without any specific treatment, even though the daily dosage of imipramine and the plasma tricyclic levels were constant or increased. Possible mechanisms of development of tinnitus and implications for tricyclic antidepressant therapy are discussed.

Adult↗
PubMed1986

Facial electromyography in depression. Subgroup differences.

To study whether facial electromyographic (EMG) activity during affective imagery differed between normal subjects and depressive subtypes, we evaluated EMG responses in 29 normal controls, 37 endogenously depressed patients, and 26 nonendogenously depressed patients. Different imagery states produced more distinctive EMG patterns in normal controls than in depressed patients. Patients with endogenous depression had EMG levels that differentiated them from normal subjects and had significantly greater absolute values than the nonendogenous group in corrugator happy and corrugator sad imagery trials. Intensity of sad and happy imagery, age, and severity of depression did not systematically correlate with EMG activity among depressive subtypes.

Adult↗
PubMed1986

Relationships of the dexamethasone suppression test to clinical severity and degree of melancholia.

Investigators continue to debate whether the Dexamethasone Suppression Test (DST) reflects clinical severity or degree of melancholia ("endogeneity"). To evaluate this question, we studied 73 drug-free inpatients diagnosed with Schedule for Affective Disorders and Schizophrenia/Research Diagnostic Criteria (SADS/RDC) as having major depressive disorder (MDD). We compared absolute and dichotomous DST values (DST suppression versus nonsuppression) with absolute and dichotomous measures of endogeneity (as measured by operationally defined RDC items) and with Hamilton Rating Scale for Depression (HRSD) scores that were collected immediately prior to treatment. We found that degree of endogeneity correlated moderately (r = 0.27) but significantly (p = 0.02) with absolute DST values; DST nonsuppression increased proportionately with changes in categorical endogenous subtype (0% of the nonendogenous patients were nonsuppressives, 52% of probable endogenous, and 61% of subjects definitely endogenous); mean values for maximum DST concentrations increased steadily with categorical endogeneity (nonendogenous, 1.44 microgram/dl; probable endogenous, 7.65 micrograms/dl; definite, 10.93 micrograms/dl; p = 0.01); HRSD scores correlated more strongly (r = 0.45, p = 0.000) with maximum DST levels than did the degree of endogeneity. Age and weight changes did not account for the relationship of endogeneity to DST values. These data suggest that maximum postdexamethasone plasma cortisol levels reflect overall severity of depression and endogeneity and that endogeneity per se is highly confounded with severity.

Adult↗
PubMed1986

Simultaneous panic and depressive disorders: clinical and sleep EEG correlates.

Panic and depressive symptoms occur simultaneously in many depressed patients. To study the frequency of this association and to determine whether patients with simultaneous panic and major depression differed from those with only major depressive disorder (MDD) in clinical features and in sleep electroencephalographic (EEG) variables, we evaluated a total sample of 336 patients with MDD. Fifty-eight (17%) had both panic and MDD; 50 had complete data and were matched for age and severity of illness with other patients having only MDD. Patients with simultaneous panic and depression had significantly higher ratings for psychic and somatic anxiety, and rapid eye movement (REM) latencies approximating normal values. Patients with only MDD (without panic disorder) rated significantly higher in guilt feelings and had shorter REM latencies. Our results suggest that the simultaneous occurrence of panic and depression is relatively frequent, is accompanied by differences in sleep EEG variables, and may have implications for treatment.

Adult↗
PubMed1986

Age effects in serial hypothalamic-pituitary-adrenal monitoring.

To evaluate age effects on hypothalamic-pituitary-adrenal (HPA) regulation in depressives, we studied 65 patients with major depressive disorder, endogenous subtype. With each patient serving as his or her own control, we compared weekly dexamethasone suppression test (DST) results among three age subgroups (less than 40 years, n = 18; 40-70 years, n = 40; greater than 70 years, n = 7). The oldest patient group had higher mean post-dexamethasone plasma cortisol concentrations both before and after treatment, and more were DST nonsuppressors. Life table analyses revealed that elderly patients who were DST nonsuppressors had significantly slower patterns of normalization during treatment and that fewer elderly patients ever achieved normal suppression. The results indicate that age effects on HPA function may be confounded with other aspects of depression, such as severity, chronicity and number of previous episodes.

Adult↗
PubMed1986

Simultaneous panic and depressive disorder: response to antidepressant treatments.

Recent publications have stressed the relevance of the simultaneous panic disorder and major depressive disorder (MDD) diagnosis from various aspects, including clinical, therapeutic and prognostic, incidence of family psychopathology, and biologic differences. Treatment outcome measures (Hamilton Depression Rating Scale scores and treatment response) were compared in two groups of patients; one group had MDD alone (N = 8) and the other had simultaneous panic disorder and MDD (N = 8). Patients with MDD alone responded significantly better to antidepressant treatment.

Adult↗
PubMed1985

Effects of antidepressant withdrawal on the dexamethasone suppression test.

Withdrawal of antidepressant medications may be a source of variance in dexamethasone suppression test (DST) results. We investigated this issue retrospectively through the serial analysis of postdexamethasone plasma cortisol concentrations and clinical severity in 15 patients and 9 control subjects before, during, and after antidepressant withdrawal. Postdexamethasone cortisol concentrations were significantly higher during the antidepressant withdrawal phase. Drug-withdrawal subjects also had an increased frequency of DST nonsuppression. Recent withdrawal of antidepressants requires further study as a possible source of variance for hypothalamic-pituitary-adrenal measures.

Adult↗
PubMed1985

Anxiety and caffeine consumption in people with anxiety disorders.

Forty-three anxiety disorder patients (DSM-III) who completed the Hopkins Symptom Checklist (SCL-90-R) and a caffeine questionnaire were compared to 124 medical inpatients. Eighty-four percent of the anxious patients were low caffeine consumers (0-249 mg/day) compared to 41% of medical inpatients; 65% of anxiety patients consumed less than 100 mg/day. In anxiety patients, there were no significant correlations between subscale scores of the SCL-90-R and amount of caffeine consumption. Patients who consumed less than 100 mg/day did not differ on anxiety subscale scores of the SCL-90-R from those who consumed more. However, patients who reported becoming anxious in response to drinking coffee had higher SCL-90-R anxiety subscale scores than patients who did not, even though their daily consumption was not different. It appears that anxiety disorder patients have increased caffeine sensitivity which leads to decreased consumption.

Adult↗
PubMed1985

Agitation-increased electromyogram activity in the corrugator muscle region: a possible explanation of the "Omega sign"?

The corrugator muscle region of the forehead has special significance in producing facial expressions associated with depression. Darwin observed in 1872 that contractions in the corrugator region produce peculiarly formed wrinkles on the forehead, referred to as "Omega Melancholium." In the present study, results from 61 right-handed, drug-free women with major depressive disorder showed a significant positive correlation between facial corrugator EMG values and psychomotor agitation. Results were not due to differences in severity of depression. These data offer preliminary evidence that agitation is reflected in corrugator muscle activity and may explain the "Omega sign" of melancholia.

Adult↗
PubMed1984

Hypothalamic-pituitary-adrenocortical activity in patients with diabetes mellitus.

Several clinical and physiologic associations between depression and diabetes mellitus have been reported. In this study, a potential neuroendocrine association was studied by measuring hypothalamic-pituitary-adrenocortical (HPA) axis activity in patients with diabetes mellitus. Plasma cortisol levels and response to dexamethasone administration were determined in 54 diabetics. Twenty-three (55%) of forty-two 1-mg dexamethasone suppression tests (DSTs) performed in 34 subjects, with eight repeated tests, and two (10%) of twenty 2-mg DSTs demonstrated a blunting of normal suppression. None of a variety of potential demographic, physiologic, or mood factors predicted nonsuppression. This study replicates prior findings that HPA dysfunction occurs in association with diabetes, and invalidates the use of the 1-mg DST as a diagnostic marker for melancholia in patients with diabetes.

Adult↗
PubMed1984

Antidepressant withdrawal-induced activation (hypomania and mania): mechanism and theoretical significance.

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)

Adrenergic Fibers↗
PubMed1984

Facial EMG activity levels predict treatment outcome in depression.

Higher electromyographic (EMG) activity levels of corrugator and zygomatic face muscles have been reported to be pretreatment predictors of better clinical outcome in depressed patients. We tested this possibility in 29 drug-free, rigorously diagnosed subjects by measuring low-level EMG activity of corrugator and zygomatic muscles during resting and three imagery states (happy, typical day, sad). All patients had major depressive disorder, endogenous subtype. Good responders had significantly higher pretreatment EMG zygomatic values and different EMG profiles. Our findings replicate and expand prior reports.

Amitriptyline↗