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Biomedical subjects

J F Greden

Publications and source records attributed to J F Greden.

At least 109 records · Page 6Linked to original sources
PubMed1984

Antidepressant withdrawal phenomena.

The authors review the antidepressant withdrawal literature. Withdrawal of tricyclic antidepressants may precipitate the development of discrete syndromes. The most common of these are general somatic or gastrointestinal distress with or without anxiety and agitation, sleep disturbance characterized by excessive and vivid dreaming and initial and middle insomnia, movement disorder, and psychic and behavioral activation extending on a continuum to frank mania. The etiology of these syndromes is discussed. The "cholinergic overdrive hypothesis" explains most antidepressant withdrawal phenomena, including infrequent manifestations. Some antidepressant withdrawal symptomatology may be due to an interaction between cholinergic overdrive and monoaminergic systems. A treatment program useful in ameliorating the distress of patients who develop antidepressant withdrawal symptoms and who cannot continue to take antidepressants is outlined. The theoretical significance of tricyclic withdrawal phenomena and the heuristic value of current hypotheses as to their pathophysiology are discussed.

Adult↗
PubMed1983

Dexamethasone suppression tests in antidepressant treatment of melancholia. The process of normalization and test-retest reproducibility.

Pilot studies suggest that changes in response to the dexamethasone suppression test (DST) in melancholic patients receiving antidepressants might represent a laboratory marker of clinical progress. We performed weekly DSTs in 31 hospitalized patients with major depressive disorder, primary and endogenous subtypes, during drug-free and subsequent treatment periods. Most nonsuppressors had progressive normalization of DST responses in conjunction with clinical improvement, DST normalization usually preceded or coincided with good clinical response, and failure to normalize was often associated with poorer clinical outcome. Occasional patients with baseline dexamethasone suppression become nonsuppressive after withdrawal from medication, but the DST has no apparent value as a serial marker in patients with well-documented normal DST findings. Our results extend the construct validity of the DST as a state-related marker in nonsuppressors and suggest future clinical applications.

Adult↗
PubMed1983

Antidepressant withdrawal syndromes: evidence supporting the cholinergic overdrive hypothesis.

The authors present case examples of the various antidepressant withdrawal syndromes. Substantial evidence supports the contention that these syndromes result from cholinergic overdrive; thus, they may have a common pathophysiological basis. Even paradoxical reactions on antidepressant withdrawal, such as mania, are consistent with the cholinergic overdrive hypothesis. If the cholinergic overdrive hypothesis of affective illness. The cholinergic overdrive hypothesis is both of considerable heuristic value and is further testable by the study of the tonic and phasic aspects of sleep and neuroendocrine parameters in the withdrawal state.

Acetylcholine↗
PubMed1983

Depressive pseudodementia: a suggested diagnostic profile.

Severe cognitive and memory impairments often occur during episodes of depression, making it difficult to differentiate true dementia from depressive pseudodementia. The dexamethasone suppression test (DST) and the computerized tomography of the brain (CT scan) may aid in this problem. Eleven patients were assessed with the Hamilton Depression Rating Scale (HDRS), a Dementia Scale (DS), the overnight DST, and CT scans. Clinicians and raters were blind to DST results. All patients initially had high DS scores. These changed in most patients following antidepressant treatments. This study suggests a profile for the diagnosis of pseudodementia. Patients with cognitive impairment, dysphoric mood, abnormal response to the DST, and normal CT scan tend to have depressive pseudodementia. Patients with the first three features but with an abnormal CT scan likely have depression and structural brain pathology. Both groups respond to antidepressant treatments, although the latter continued to have some cognitive dysfunction during euthymia. A third group, the "true" dementia patients, may have abnormal CT scans and a normal DST response but larger samples are needed for confirmation.

Aged↗
PubMed1983

Imipramine-induced tremor: effects of a beta-adrenergic blocking agent.

Assessment of an elderly depressed patient with an imipramine-induced tremor led to the conclusions that imipramine tremor (1) can be severe and incapacitating, (2) is most pronounced early in the treatment, (3) does not seem to be dose-related, and (4) is readily reversible with a beta-adrenergic blocking agent.

Depressive Disorder↗
PubMed1983

The dexamethasone suppression test in patients with alcoholism.

It is unknown whether the dexamethasone suppression test (DST) can be used to help identify patients with major depressive disorder if they have recently been abusing alcohol. We evaluated 38 male alcoholics with Research Diagnostic Criteria (RDC), the Beck Depression Inventory (BDI), and the standardized overnight 1-mg DST, administered after 3-4 weeks of detoxification. Eighty-two percent had a normal suppressive DST response. The DST may be useful in aiding identification of patients with a profile of major depressive disorder and continued depression after alcohol detoxification. The test might facilitate a rational selection of alcoholics who may benefit from antidepressants. However, the possibility of false positive results must be further investigated.

Alcohol Drinking↗
PubMed1982

Application of biological markers in depression secondary to thyrotoxicosis.

Biological markers of affective disorders have not been studied intensively in patients with secondary depression. An elderly woman with severe delusional depression secondary to thyrotoxicosis was monitored with weekly dexamethasone suppression tests (DSTs) and three sleep electroencephalography (EEG) evaluations. She received treatment only for her thyrotoxicosis, but her depression resolved completely. The serial DSTs were normal throughout her depression, consistent with the specificity of this test for primary endogenous depression. The sleep EEG erroneously suggested a diagnosis of primary depression but effectively monitored clinical improvement. Biological markers may have applicability in evaluating and monitoring patients with secondary depression.

Aged↗