Treatment of tricyclic refractory depression with a monoamine oxidase inhibitor antidepressant.
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Adolescent↗
Biomedical subjects
W Harrison
Publications and source records attributed to W Harrison.
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↗
Endophotocoagulation in vitrectomy with a carbon dioxide laser.
A continuous-wave carbon dioxide laser operating at a wavelength of 10.6 microns has been applied transvitreally by means of a miniature articulating arm and intraocular probe to produce chorioretinal lesions in albino white rabbit eyes. The advantages of using a carbon dioxide laser are its lack of pigment dependence, its ability to act both as a photocoagulator and as a phototransector, and its ability to deposit its energy in a well-defined area without adverse effect on neighboring ocular tissue. The main disadvantage of the carbon dioxide laser in vitreoretinal surgery is that in a fluid medium, such as the vitreous, the laser tip must be placed in direct physical contact with the target tissue to obtain a reaction.
Animals↗
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↗
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↗
Treatment of experimental methicillin-resistant Staphylococcus epidermidis endophthalmitis with intravitreal vancomycin.
Endophthalmitis remains a dreaded complication of intraocular surgery and penetrating eye trauma. Subconjunctival, topical, and systemic antibiotics have been largely ineffective in the treatment of endophthalmitis, whereas intravitreal antibiotics have proved efficacious. Methicillin-resistant Staphylococcus epidermidis has become an important pathogen in many infections, including endophthalmitis. Toxicity, clearance, and efficacy of intravitreal vancomycin were evaluated in the treatment of experimental methicillin-resistant S. epidermidis endophthalmitis. No evidence of retinal toxicity was found and therapeutic levels were demonstrated six days after injection. The treated rabbit eyes showed a marked beneficial effect when compared to the untreated eyes. If experience confirms the safety of intravitreal vancomycin in human eyes, vancomycin should be considered the drug of choice for methicillin-resistant S. epidermidis endophthalmitis.
Animals↗
Phenelzine for chronic depression: a study of continuation treatment.
Several controlled studies have demonstrated the efficacy of continuation therapy with tricyclic antidepressants, but little is known about continuation therapy with the monoamine oxidase inhibitors. Moreover, the usefulness of continuation antidepressant therapy in patients with chronic depressive disorders has not been evaluated. This pilot study reports initial results of a double-blind continuation trial of phenelzine or placebo following an initial antidepressant response to phenelzine in 12 patients who met DSM-III criteria for dysthymic disorder. All 7 patients randomized to placebo relapsed, whereas only 1 of the 5 patients who continued to receive phenelzine relapsed. These results suggest that continuation therapy with phenelzine may be useful in maintaining clinical response after acute treatment.
Chronic Disease↗
Phenelzine treatment of melancholia.
Monoamine oxidase (MAO) inhibitor antidepressants are widely thought by clinicians and researchers to be ineffective in the treatment of endogenous depression. This study reports an open clinical trial in which seven of eight outpatients (88%) with melancholia responded to phenelzine treatment. This response rate is comparable to the response to tranylcypromine in a previous study at our clinic. These results suggest that MAO inhibitors are effective for outpatients with endogenous depressive syndromes. The use of MAO inhibitors may be an alternative treatment for patients who cannot tolerate or who have not responded to tricyclic antidepressants.
Adult↗
Follow-up of patients who improved during placebo washout.
Depressed patients who showed significant improvement after a 10-day placebo washout trial were followed for 3 months. Twenty-five relapsed and 20 remained well. Relapsing patients more frequently had a family history of depression, more had prior psychiatric treatment, their illness course was more chronic once ill, mean age of onset was younger, and fewer had obvious precipitants. More relapser had RDC diagnoses of intermittent depressive disorder. Among those with major depressive disorder, fewer relapsers met subtype criteria for simple, situational, or recurrent. Nonaffective psychiatric disorders were present in 64% of relapsers and no placebo responders who remained well. Overall, 10-day placebo responders included patients with different clinical characteristics and subsequent course.
Adult↗
Treatment outcome validation of DSM-III depressive subtypes. Clinical usefulness in outpatients with mild to moderate depression.
An algorithm for transcribing Research Diagnostic Criteria diagnoses for depressive disorders to similar categories in the DSM-III was applied to 103 depressed outpatients previously diagnosed by Research Diagnostic Criteria. All had Hamilton Depression Rating Scale scores of 18 or less. Among 64 patients completing a six-week, double-blind study comparing desipramine hydrochloride with placebo, desipramine was significantly more effective than placebo in patients with DSM-III major depression but not in those with dysthymic disorder. Among patients with major depression, a significant drug-placebo response difference was demonstrated even in those without melancholia. These findings support the clinical usefulness of the DSM-III in the treatment of depressed outpatients. Independent of DSM-III diagnosis, however, evidence of panic attacks seemed to identify patients who benefited from desipramine therapy. This suggests that the DSM-III hierarchy, which excludes consideration of panic in patients with major depression, may require revision.
Anxiety Disorders↗
Treatment of premenstrual symptoms.
The etiology of premenstrual syndrome is unknown. A wide variety of etiological explanations has been suggested, but controlled studies based on these theories have generally failed to provide confirmation. This article reviews the literature on treatment of premenstrual symptoms and provides some practical suggestions for clinical management.
Bromocriptine↗
Placebo-controlled study of mianserin in depressed outpatients.
Ninety-two outpatients with depressive disorders which met Research Diagnostic Criteria were treated either with mianserin or placebo in a 6-week controlled trial. Twenty-four of 42 (57%) mianserin-treated patients were rated responders to mianserin treatment while 15 of 50 (30%) were rated responders to placebo treatment (chi 2 = 6.89, p less than 0.01). This rate of drug response was comparable to that achieved with a tricyclic antidepressant in a similar study done in our clinic, supporting the use of mianserin in mildly depressed outpatients.
Adolescent↗
Adverse reactions to monoamine oxidase inhibitors. Part II. Treatment correlates and clinical management.
From a review of the clinical charts of 198 depressed outpatients, information was extracted on common major treatment emergent side effects associated with phenelzine, tranylcypromine, and imipramine. These included hypertensive reactions, severe orthostatic hypotension, hypomania, significant weight gain, sexual dysfunction, and a residual category of multiple side effects which together culminated in drug discontinuation. In this report, frequency of their occurrence for each drug, level of severity, relation to dose and treatment duration, and physician response at the time the side effect was recorded are described. In addition, procedures found useful in the clinical management of these side effects are discussed.
Adult↗
Lactate infusion in patients with depression and anxiety.
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Adolescent↗
Effect of panic attacks on the treatment of atypical depressives.
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Adolescent↗
Phenelzine v imipramine in atypical depression. A preliminary report.
Sixty patients meeting 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 67% with phenelzine, 43% with imipramine, and 29% with placebo. At week 6, phenelzine was superior to placebo on many measures, while the superiority of imipramine to placebo was confined to several variables. Phenelzine was superior to imipramine on the interpersonal sensitivity and paranoia factors of the 90-item Hopkins Symptom Checklist, with trends toward superiority on several other measures, while imipramine was not differentially superior on any measure. Atypical depressive patients with a history of spontaneous panic attacks and hysteroid dysphoric patients both showed extremely low rates of response to placebo and high rates of response to phenelzine. Conversely, those without panic or hysteroid dysphoric features responded equally to all three treatments. Responders to pheneizine also had greater platelet monoamine oxidase inhibition while receiving drug therapy than did nonresponders. Completion of the 120-patient sample will allow more detailed analyses.
Adolescent↗
l-Deprenyl in atypical depressives.
We investigated the antidepressant efficacy of l-deprenyl (selegiline), a selective monoamine oxidase B inhibitor (MAOI), in a six-week open trial of 17 patients with atypical depression. Such patients have previously been shown to benefit from nonselective MAOIs such as phenelzine sulfate. Ten patients (59%) responded to l-deprenyl, but nine required dosages above the 10 to 20 mg/day used in previous investigations. l-Deprenyl was superior to six weeks of placebo administered to diagnostically similar patients in a separate double-blind study. In contrast with previous findings with pheneizine, responders to l-deprenyl differed from nonresponders by having lower baseline anxiety ratings. Even at high dosages, there appeared to be fewer side effects with l-deprenyl than with nonselective MAOIs.
Adult↗
Cortisol response to dextroamphetamine stimulation in depressed outpatients.
Endogenously depressed inpatients often fail to release cortisol following intravenous (i.v.) amphetamine, unlike nondepressed control subjects. We therefore assessed the ability of i.v. dextroamphetamine, 0.15 mg/kg, to induce cortisol release in 64 depressed outpatients diagnosed according to Research Diagnostic Criteria (RDC). After dextroamphetamine challenge, more patients with major depression failed to release substantial cortisol (30%) than those without major depression (5%). Major depressives with endogenous subtype failed to release cortisol (38%) more frequently than those without endogenous depression (23%), but this difference was not significant. After baseline cortisol, sex, and weight loss were controlled for in a regression analysis, however, RDC diagnosis of major depression or endogenous subtype did not account for significant additional variance in cortisol release. In outpatients, abnormal cortisol response to amphetamine may be more closely related to baseline cortisol, sex, and history of weight loss than to RDC subtype of depression.
Adult↗