Biomedical subjects

R David Ekstrom

Publications and source records attributed to R David Ekstrom.

5 recordsLinked to original sources

PubMed2005

The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence.

OBJECTIVE: The purpose of this study was to assess the evidence base for the efficacy of light therapy in treating mood disorders. METHOD: The authors systematically searched PubMed (January 1975 to July 2003) to identify randomized, controlled trials of light therapy for mood disorders that fulfilled predefined criteria. These articles were abstracted, and data were synthesized by disease and intervention category. RESULTS: Only 13% of the studies met the inclusion criteria. Meta-analyses revealed that a significant reduction in depression symptom severity was associated with bright light treatment (eight studies, having an effect size of 0.84 and 95% confidence interval [CI] of 0.60 to 1.08) and dawn simulation in seasonal affective disorder (five studies; effect size=0.73, 95% CI=0.37 to 1.08) and with bright light treatment in nonseasonal depression (three studies; effect size=0.53, 95% CI=0.18 to 0.89). Bright light as an adjunct to antidepressant pharmacotherapy for nonseasonal depression was not effective (five studies; effect size=-0.01, 95% CI=-0.36 to 0.34). CONCLUSIONS: Many reports of the efficacy of light therapy are not based on rigorous study designs. This analysis of randomized, controlled trials suggests that bright light treatment and dawn simulation for seasonal affective disorder and bright light for nonseasonal depression are efficacious, with effect sizes equivalent to those in most antidepressant pharmacotherapy trials. Adopting standard approaches to light therapy's specific issues (e.g., defining parameters of active versus placebo conditions) and incorporating rigorous designs (e.g., adequate group sizes, randomized assignment) are necessary to evaluate light therapy for mood disorders.

Adult↗

PubMed2005

The relationship between psychiatry residency applicant evaluations and subsequent residency performance.

OBJECTIVE: The goal of this study was to measure the predictive value of applicant evaluations for a psychiatry residency in terms of the subsequent performance of those who matriculated in the program. METHOD: The match lists for resident cohorts beginning their course of training over 4 years were divided into thirds, which served as our primary, preresidency measure of expected performance. The preresidency applicant evaluations of those residents who entered were compared to their postresidency evaluations. RESULTS: There was no significant association between preresidency selection evaluations and postresidency final evaluations in any of the four cohorts of trainees. CONCLUSIONS: The overall results of this study of four cohorts of residents indicate only a small, nonsignificant association between pre- and postresidency evaluations. Further efforts to predict residency performance in applicants may help identify those trainees who might benefit from additional monitoring and supervision.

Education↗

PubMed2003

Effect of stress on pregnancy outcome among women undergoing assisted reproduction procedures.

BACKGROUND: This study was performed to examine the effect of stress on pregnancy outcome in women who underwent assisted reproductive technology (ART) procedures. METHODS: In a controlled clinical study of healthy volunteers in an academic research environment, stress was measured subjectively by administering patient questionnaires and biochemically by examining urinary excretion of cortisol and 6-sulfatoxy-melatonin (6-SM), the primary metabolite of melatonin and a marker of peripheral stress response. A total of 42 women who underwent ART procedures during an 18-month period agreed to participate in the study and were enrolled consecutively. The women collected 24-hour urine specimens on the day after human chorionic gonadotropin administration and concurrently completed the State-Trait Anxiety Inventory questionnaire. We measured the cortisol and 6-SM levels in the urine collection for each of the 42 women and for 10 oocyte donors who served as controls. Pregnancy tests were performed 14 days after embryo transfer. Analysis of covariance was used to compare the relationship of stress ratings to urinary cortisol and 6-SM levels among the women who became pregnant, the women who did not, and the women who served as controls. Other variables were explored by performing chi2 analysis and Fisher's exact test. RESULTS: Neither self-ratings of acute anxiety, nor total daily 6-SM value, nor cortisol levels were associated with pregnancy outcome in the ART procedures. CONCLUSION: Biochemical markers of stress failed to support a deleterious effect of stress on pregnancy outcome in women who underwent ART procedures. Subjective measurement of stress levels did not differ between women who became pregnant and those who did not.

Adolescent↗

PubMed2003

The effects of mirtazapine on plasma lipid profiles in healthy subjects.

BACKGROUND: The novel antidepressant mirtazapine has been linked to elevated random plasma total cholesterol (TC) levels. The purpose of this study was to evaluate in a more controlled and precise approach the putative effects of mirtazapine on plasma lipids. METHOD: In a double-blind design, 50 healthy subjects (30 women and 20 men) were randomized to receive either mirtazapine (N = 28) or placebo (N = 22) for a 4-week period. The study was conducted from June 1997 to September 1998. The initial dose for the mirtazapine group was 15 mg daily, which was increased to 30 mg daily at the beginning of the second week. Body weight and plasma lipoprotein profiles, including TC, low-density lipoproteins (LDL), high-density lipoproteins (HDL), and triglycerides, were determined at baseline and at weekly intervals throughout the study period. RESULTS: At baseline, there were no group differences in any of the measures. There was a statistically significant increase of 2.5% in mean body weight over the course of the study in the mirtazapine group that appeared to reach a plateau at 3 weeks, while no increase was observed in the placebo group. Mirtazapine subjects also showed significantly increased TC at week 4 (p =.016) and a transient rise in triglycerides that normalized by week 4. No significant changes in any of the other lipid parameters, including HDL, LDL, and TC/HDL ratios, were observed within either group. Changes in TC were significantly and positively correlated with changes in weight (p <.01). CONCLUSION: These results suggest that while mirtazapine may be associated with increased TC, it does not increase LDL levels or affect the ratio of TC to HDL.

Adult↗

PubMed2002

A longitudinal study of serotonergic function in depression.

Several reports have described abnormal neuroendocrine responses to serotonergic challenge tests in depression, but few have studied depressed patients followed longitudinally. In order to determine whether blunted prolactin responses to clomipramine challenge is a "state" vs. "trait" marker in depression, we applied this challenge paradigm to 20 patients with Major Depression prior to treatment and at three additional time points following response to desipramine: at the completion of acute treatment; at the end of the continuation phase of treatment; and after a minimum of three weeks "washout" following the discontinuation of treatment. The prolactin response to clomipramine challenge was blunted in depressed patients compared with matched healthy control subjects, at each time point over the longitudinal course of their illness and recovery. Challenge test results in depressed patients did not change after response to acute desipramine therapy, at the conclusion of the continuation phase of treatment, or while in a medication-free state of remission. Blunted prolactin response to clomipramine challenge persists in depressed patients after recovery from acute illness, and may reflect an underlying biological vulnerability.

Adult↗