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Biomedical subjects

R T Joffe

Publications and source records attributed to R T Joffe.

At least 19 recordsLinked to original sources
PubMed1992

Diagnostic specificity of the dependent and self-critical personality dimensions in major depression.

Validational studies of self-critical and dependent personality dimensions as vulnerability factors for depression have been tested primarily with depressed samples, employing research designs devised to address state vs. trait and trait-situational congruity issues. In this study we examined the diagnostic specificity to depression of these two personality dimensions, comparing Self-Criticism and Dependency scores as measured by the Depressive Experiences Questionnaire (DEQ) in two samples of outpatients: (1) panic disorder with agoraphobia; and (2) non-psychotic, unipolar major depression. As hypothesized, the two groups differed on Self-Criticism, with the depressed group scoring higher, but no differences were found for Dependency. These findings were similar even when depressed mood was partialed out. These results complement a growing body of research associating Self-Criticism, as specifically measured by the DEQ, with depression.

Adult↗
PubMed1992

The thyroid and melancholia.

Several studies that have examined heterogeneous groups of patients suggest that altered thyroid function may distinguish melancholic from nonmelancholic depression. We therefore measured basal thyroid hormone levels in 90 unipolar depressed patients who were divided into melancholic and nonmelancholic subgroups according to three definitions. Levels of thyroxine, triiodothyronine, and thyrotropin, obtained using an ultrasensitive assay, did not distinguish the subtypes of depression. However, severity of depression contributed significantly to the difference between these subtypes according to DSM-III and Research Diagnostic Criteria.

Adult↗
PubMed1992

Triiodothyronine potentiation of fluoxetine in depressed patients.

Triiodothyronine (T3) has been shown to augment the therapeutic effect of tricyclic antidepressants as well as monoamine oxidase inhibitors. In this report, three cases of T3 potentiation of the antidepressant effect of fluoxetine are described. The results suggest that T3 augmentation may be effective with a wide range of antidepressants.

Adult↗
PubMed1992

Psychiatric morbidity during the early phase of coronary care for myocardial infarction: association with cardiac diagnosis and outcome.

We evaluated the association of psychiatric morbidity during the early phase of admission to a coronary care unit with cardiac diagnosis and subsequent morbidity. Ninety-two patients admitted for the first time for presumed myocardial infarction were evaluated within 48 hours of hospitalization. Anxiety and depressive symptoms and cognitive impairment were rated. Data were collected on cardiac diagnosis and morbidity. Three and 12 months after hospitalization, cardiac morbidity, psychiatric symptoms and psychosocial morbidity were assessed.

Adult↗
PubMed1992

Antidepressants and thyroid hormone levels.

We assessed the effect of treatment with the tricyclic antidepressant, desipramine, on peripheral thyroid hormone levels in 28 severely depressed patients. Only those whose depression responded showed a decrease in their thyroxine levels without alteration of other thyroid function tests. In a second study involving 38 depressed patients, we observed an increased response to antidepressant treatment with the addition of triiodothyronine but not equivalent doses of thyroxine (T4). The finding is consistent with the decreases in plasma T4 levels which accompany an antidepressant response to desipramine.

Depressive Disorder↗
PubMed1992

T3 augmentation of antidepressant treatment in T4-replaced thyroid patients.

BACKGROUND: Clinicians may not consider using the thyroid hormone liothyronine sodium (levorotary isomer of triiodothyronine [T3]) for augmentation of antidepressant drugs in depressed patients who are also receiving the precursor hormone levothyroxine (levorotary isomer of thyroxine [T4]) for thyroid disease. We now report on the successful use of T3 augmentation therapy in seven of nine depressed patients who were also receiving T4 for thyroid disease. METHOD: Following an earlier single case report, we prescribed T3 augmentation therapy for eight depressed patients who had not responded to an adequate antidepressant drug trial and who were receiving T4 therapy for thyroid disease. T3 was prescribed in open-label fashion, and response was judged by the clinician, whose assessment was supplemented by the use of standardized rating scales. RESULTS: Seven of the nine patients were judged to respond to T3 augmentation. CONCLUSION: These results are consistent with a report of differential effects for T3 versus T4 augmentation in depressed patients free of thyroid disease. The results have implications for the treatment of depression in the presence of thyroid disease and for the mechanism of thyroid hormone potentiation of antidepressants.

Antidepressive Agents↗
PubMed1991

Personality and family history of depression in patients with affective illness.

The presence of a family history of depression may distinguish clinically important subgroups of depressed patients. Depressed patients with and without a family history of depression may differ on several clinical features. There are limited data, however, on potential differences in personality variables between patients with and without familial depression. We examined personality measures in 41 depressed subjects with and without a familial history of depression in both the depressed and remitted state. Patients with no family history of depression had significantly higher mean personality trait scores on the dependent and compulsive personality scales. The clinical and theoretical implications of these findings are discussed.

Adult↗
PubMed1991

Seasonal variation of peripheral thyroid hormone levels in major depression.

The seasonal variation in thyroid function tests was examined in 138 patients with major depression. No alterations in thyroxine, free thyroxine index, triiodothyronine, T3 resin uptake and thyrotropin were observed across the four seasons. This applied to both male and female subgroups. These data suggest that seasonality does not account for the wide variability in abnormalities of thyroid function reported in depression.

Adult↗
PubMed1991

Lack of beneficial effects of l-baclofen in affective disorder.

GABAB mechanisms have been implicated in the antinociceptive, but not anticonvulsant effects of carbamazepine. A variety of antidepressants have been reported to upregulate GABAB receptors after chronic administration. The GABAB agonist l-baclofen was studied in depressed patients based on two separate rationales. l-Baclofen, in doses ranging from 10-55 mg/day, was administered to five patients with primary affective disorder. No patient showed a positive clinical response, while three patients showed a pattern of increasing depression or cycling during treatment and improvement during withdrawal. These preliminary data suggest that GABAB agonism is unlikely to produce antidepressant effects and may be unrelated to the mechanism of carbamazepine's antidepressant action. These data, taken with a reinterpretation of other findings that antidepressant modalities upregulate GABAB receptors in brain following chronic administration, suggest that GABAB antagonism rather than agonism may be a fruitful clinical strategy to explore in depression.

Adult↗
PubMed1991

Life course of depressive illness and characteristics of current episode in patients with double depression.

It has been suggested recently that major depression and concurrent chronic minor depression, or "double depression" (DD), may have a different course and presentation from major depression alone (MDA). The present study compares 41 patients with DD and 60 patients with MDA for differences in life course of depressive illness and characteristics of the current depressive episode. Patients with DD, as compared with patients with MDA, had an earlier age of onset of mood disturbance, more episodes of major depression, and more frequent concurrent anxiety disorders. However, patients with DD were not significantly different from patients with MDA who had greater than a 6-month history of mood disturbance, with regard to life course of illness variable. The characteristics of current depression in patients with DD and MDA were not significantly different. The clinical and theoretical implications of these findings are discussed.

Adult↗
PubMed1991

Acute psychostimulant challenge in primary obsessive-compulsive disorder.

The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had a significantly greater antiobsessive-compulsive effect as measured by the Comprehensive Psychiatric Rating Scale--Obsessive-Compulsive Subscale, as compared with placebo. This effect appeared unrelated to their effect on depression although a differential effect of the two psychostimulants on anxiety was observed. Although both these stimulants affect serotonin, the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder.

Adult↗
PubMed1991

Neuroendocrine testing in electroconvulsive therapy.

Dysregulation of specific neuroendocrine axes is seen frequently in patients with depressive disorder. Electroconvulsive therapy (ECT) causes both acute and chronic changes in numerous neuroendocrine parameters. The measurement of serum and cerebrospinal levels of hormones as well as the development of specific challenge tests have allowed the identification of potential state-specific markers for depression. These markers offer the potential for predicting both outcomes of treatment with ECT and long-term prognosis.

Electroconvulsive Therapy↗
PubMed1991

Bright light augmentation in antidepressant nonresponders.

BACKGROUND: This study was designed to examine the potential benefit of the addition of bright lights to antidepressant treatment in depressed subjects. METHOD: Ten patients who presented during the winter months with major depression and who had failed an adequate trial of antidepressants or who had relapsed following a successful course of antidepressants underwent a 2-week course of bright light therapy. RESULTS: Augmentation with bright lights resulted in substantial improvement in 7 of the 10 patients. CONCLUSION: Bright light augmentation may provide a useful treatment alternative for patients with treatment-resistant depression.

Adult↗