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Biomedical subjects

A H Glassman

Publications and source records attributed to A H Glassman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Cardiovascular effects of antidepressant drugs: updated.

The cardiovascular effects of tricyclic antidepressants (TCAs), including the propensity of these agents to be fatal in overdose, have been well described. It has been established further that even at therapeutic doses the TCAs may have untoward cardiovascular effects in the context of underlying ischemic heart disease. By comparison, the selective serotonin reuptake inhibitors (SSRIs) as a class are less likely to affect cardiovascular parameters in depressed patients who are otherwise healthy. Importantly, the SSRIs in overdose situations are enormously safer than TCAs and rarely have been associated with cardiotoxic effects when ingested alone. More recently, the safety and efficacy of several of the SSRIs have been evaluated in patients with existing ischemic heart disease. Although the studies have involved a limited number of patients, the available data suggest that SSRIs are not associated with adverse cardiovascular effects in these patients and are safer than TCAs in the treatment of depression in patients with heart disease. The prevalence of cardiovascular disease and the evidence that comorbid depression with cardiovascular disease (for example, following myocardial infarction) increases the risk of mortality underscore the importance of understanding the cardiac effects of antidepressants and the need for effective antidepressants that are free of adverse cardiovascular effects. At present, the SSRIs should be considered first-line agents for the treatment of depressed patients with cardiovascular illness, particularly ischemic heart disease. Among the SSRIs, those with a lower potential for causing pharmacokinetic drug interactions generally are preferred.

Antidepressive Agents, Tricyclic↗
PubMed1997

Citalopram toxicity.

Explore the source record for details and available documents.

Antidepressive Agents↗
PubMed1997

Contribution of genetic and nutritional factors to DNA damage in heavy smokers.

Prior epidemiological evidence suggests that genes controlling the metabolism of carcinogens and antioxidant/nutritional status are associated with lung cancer risk, possibly through their ability to modulate DNA damage by carcinogens. We performed a cross-sectional analysis of 159 heavy smokers from a cohort of subjects enrolled in a smoking cessation program. A total of 159 blood samples were analyzed to determine the relative contributions of genetic polymorphisms [CYP1A1 MspI and exon 7 and glutathione S-transferase M1 (GSTM1)] and plasma micronutrients to polycyclic aromatic hydrocarbon-DNA (PAH-DNA) adduct levels. DNA damage in smokers was affected by genetic polymorphisms and nutritional status. Smokers with the CYP1A1 exon 7 valine polymorphism had significantly higher (2-fold, P < or = 0.03) levels of DNA damage than those without. In parallel models, PAH-DNA adducts were inversely associated with plasma levels of retinol (beta = -0.93, P = 0.01), beta-carotene (beta = -0.18, P = 0.09), and alpha-tocopherol (beta = -0.28, P = 0.21) in 159 subjects. The association between smoking-adjusted plasma beta-carotene levels and DNA damage was only significant in those subjects lacking the GSTM1 detoxification gene (beta = -0.30, P = 0.05, n = 75). There was a statistical interaction between beta-carotene and alpha-tocopherol; when beta-carotene was low, alpha-tocopherol had a significant protective effect (beta = -0.78, P = 0.04) on adducts, but not when beta-carotene was high (beta = -0.16, P = 0.57). Plasma alpha-tocopherol was significantly correlated with beta-carotene (r = 0.36, P = 0.0005) and less strongly with retinol (r = 0.20, P = 0.0005). These results suggest that several micronutrients may act in concert to protect against DNA damage and highlight the importance of assessing overall antioxidant status. In conclusion, a subset of smokers may be at increased risk of DNA damage and possibly lung cancer due to the combined effect of low plasma micronutrients and genetic susceptibility factors. The use of biological markers to assess efficacy of interventions and to study mechanisms of micronutrients is timely given the current debate regarding the use of chemopreventive agents in high risk populations.

Adult↗
PubMed1997

Major depression following smoking cessation.

OBJECTIVE: The authors examined the incidence and predictors of major depression following successful smoking cessation treatment, with special attention to the influence of past major depression. METHOD: Three-month follow-up data were obtained from 126 subjects who successfully completed a 10-week smoking cessation program. RESULTS: The 3-month incidence of new major depression following treatment for nicotine dependence was 2%, 17%, and 30% among subjects with histories of no major depression, single major depression, and recurrent major depression, respectively. A history of major depression and persistent withdrawal symptoms independently predicted posttreatment major depression. CONCLUSIONS: Continued patient care beyond the 2-4-week period associated with the nicotine withdrawal syndrome is indicated when abstinence is attempted by smokers with prior major depression.

Depressive Disorder↗
PubMed1997

[The central nervous system, depression and cardiac death].

There is now convincing evidence of a link between depression and cardiovascular death. This evidence comes from prospective studies of healthy populations, and from studies of patients with ischaemic heart disease. It has recently become clear that there is a strong association between smoking and depression. This gave rise to the hypothesis that the association between cardiovascular disease and depression was an artefact due to smoking. The National Health Examination Follow-up Study (NHEFS) settled the question. Three thousand adults without clinical disease at the start of the study were followed up for 12.5 years. After controlling for smoking and other known risk factors, depression was found to be a predictive factor for an increased risk of fatal and non-fatal ischaemic heart disease. Camey et al. in 1988 studied patients rather than healthy subjects, and showed that among patients undergoing coronary angiography, those suffering from major depression had a higher risk of myocardial infarction and of death during the next 12 months than non-depressed patients. Two years later, Ahern et al, found that patients presenting with ventricular arrhythmias following myocardial infarction had a higher risk of death during the following year if they suffered from depression. However, the best study by far is that of Frasure-Smith et al. (1993). They followed up 222 consecutive patients who had suffered a myocardial infarction, and demonstrated that the development of major depression was a significant predictive factor for death during the following 6 months (adjusted risk ratio: 4.29). By the end of 18 months, those patients who had only a slight elevation of the Beck score in the intensive care unit had the same risk of death as those showing symptoms of major depression. As regards the question of whether treatment for depression can alter the risk of death in patients suffering from ischaemic heart disease, and what are the mechanisms underlying these risks, the jury is still out.

Adult↗
PubMed1996

Depression after smoking cessation: case reports.

BACKGROUND: Cigarette smokers with a history of major depression are at risk for developing depressive mood when they attempt cessation. Whether cessation can also provoke more severe depressions, however, has not been well documented. METHOD: Six case reports of severe depressive episodes after smoking cessation are described. RESULTS: Four cases occurred among smokers with a history of major depression but who were not depressed at the time of cessation. Two cases involved smokers with no previous history of major depression. Variability in both the timing and the outcome of the postcessation depressions was observed. CONCLUSION: The risk that depressive states may emerge or be exacerbated after smoking cessation, particularly in patients with a history of major depression, must be kept in mind in the treatment of nicotine dependence.

Acute Disease↗
PubMed1995

Mood, major depression, and fluoxetine response in cigarette smokers.

OBJECTIVE: Two smoking cessation studies provided venues to 1) look for differences in affective symptoms between cigarette smokers with and without a history of major depression or other psychiatric diagnoses who were not currently depressed and 2) evaluate the efficacy of fluoxetine in ameliorating affective symptoms in smokers with a history of major depression but not currently depressed. METHOD: Part I: Three hundred sixty-eight smokers who enrolled in a smoking cessation treatment study completed baseline self-rating scales. The relationship between the scale scores and a history of major depression and other psychiatric diagnoses was examined. Part II: Thirty-nine smokers with a history of major depression were enrolled in a randomized, double-blind study that examined the utility of fluoxetine as an aid to smoking cessation. Self-rated scales were compared at baseline and after 3 weeks of medication treatment before the attempt to quit. RESULTS: A history of major depression had significant main effects across all scale scores; subjects with such a history rated themselves as more symptomatic. The effects of other psychiatric diagnoses were neither as pervasive nor as robust. There were no differences in baseline scores between the fluoxetine- and placebo-treated groups and no change within the placebo group after 3 weeks. There was significant improvement from baseline in several subscale scores for the group treated with fluoxetine. However, comparison of the score changes for the placebo and fluoxetine groups did not show a statistically significant difference, which limited the ability to conclude that active treatment was better than placebo. CONCLUSIONS: Subjects with a history of major depression, but without current affective illness, reported themselves to be more symptomatic than those without such-a history. Furthermore, in a group of smokers with a history of major depression, affective symptoms, without concurrent syndromal illness, may be ameliorated by treatment with fluoxetine.

Adult↗
PubMed1995

Cementless femoral components should be made from cobalt chrome.

Before 1982, the authors performed 177 primary total hip arthroplasties using a single-sized, extensively porous-coated cobalt-chrome femoral prosthesis. The current status of 122 of these arthroplasties is known. Two femoral prostheses have been revised for late symptomatic loosening, 2 for stem fracture, and 1 for infection. From 1982 to 1984, 227 primary arthroplasties were performed using the same stem in multiple sizes. Of these cases, 171 are available for followup. One stem (0.6%) has been revised for symptomatic loosening. Large osteolytic femoral lesions (average size, 8.1 cm2) developed in 3 patients, associated with an unusually large amount of polyethylene wear of their acetabular components. These patients have been treated by exchange of the polyethylene liner within the porous-coated acetabular component and allografting of the osteolytic lesions. The femoral components were not exchanged because osteolysis had not eroded the integrity of the supporting bone-implant interface to a point where loosening occurred. Before 1987, 193 patients with loose femoral components were treated with revision total hip arthroplasty, also using an extensively porous-coated cobalt-chrome femoral stem of similar design. Ten (5.7%) patients have required rerevision of the femoral prosthesis. Six of these 10 rerevisions were performed because of symptomatic loosening. Ninety-three percent of the patients in the primary series had relief of their preoperative pain and have improved functional ability; 94.2% are satisfied with their results. In the revision series, 89.1% of the patients are free of pain and function better than preoperatively, and 89.6% are fully satisfied with their results.(ABSTRACT TRUNCATED AT 250 WORDS)

Chromium Alloys↗
PubMed1994

Risks of antidepressants in the elderly: tricyclic antidepressants and arrhythmia-revising risks.

Unexpected events have occurred in cardiology over the last 4 years. A study by the Heart and Lung Institute of the National Institute of Health in the mid-1980s showed to great surprise that class I antiarrhythmic drugs given to patients with ventricular arrhythmias following myocardial infarction, instead of preventing deaths, actually increased the number of patients dying. Since then, a series of studies has consistently confirmed this original observation. The problem for psychiatry is that the tricyclic antidepressant (TCA) drugs are also class I antiarrhythmics. There is every reason to believe that a similar increased risk of death would exist with the TCAs. It is, therefore, important for psychiatrists to understand the cause and magnitude of this excess in deaths. Evidence to date would suggest that all class I compounds, despite being powerful antiarrhythmics under usual physiological conditions, become proarrhythmic under anoxic conditions. Such conditions would exist in ischaemic heart disease during angina and, particularly, myocardial infarction. How this might alter our use of TCAs and whether this happens with the selective serotonin reuptake inhibitors is discussed.

Aged↗
PubMed1994

Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia.

OBJECTIVE: The popularity of selective serotonin reuptake inhibitors stems from their apparent efficacy for numerous disorders and their favorable side effect profile. However, several studies have suggested that selective serotonin reuptake inhibitors may be relatively ineffective for treating melancholia. The objective of this study was to compare the responses to fluoxetine and nortriptyline of older patients with both severe depression and heart disease. METHOD: The outcome of 22 hospitalized patients with unipolar depression and heart disease who were treated with fluoxetine was compared to the outcome of 42 comparable patients treated with nortriptyline. The average age of the fluoxetine group was 73 years, and their mean pretreatment score on the Hamilton Depression Rating Scale was 26; the average age of the nortriptyline group was 70, and their mean pretreatment Hamilton score was 28. RESULTS: Of the 42 nortriptyline-treated patients, 28 were responders, six were nonresponders, and eight dropped out. The intent-to-treat response rate was 67% (28 of 42), and the response rate of the melancholic patients who completed the nortriptyline trial was 83% (20 of 24). Of the 22 fluoxetine-treated patients, five were responders, 13 were nonresponders, and four dropped out. The intent-to-treat response rate was 23% (five of 22), and the response rate of the melancholic patients who completed the fluoxetine trial was 10% (one of 10). CONCLUSIONS: Fluoxetine appears to be significantly less effective than nortriptyline for treating hospitalized elderly patients with unipolar major affective disorder, especially those with the melancholic subtype and concurrent cardiovascular disease.

Age Factors↗
PubMed1994

Antidepressant choice in the patient with cardiac disease: lessons from the Cardiac Arrhythmia Suppression Trial (CAST) studies.

At one point it was believed that the systematic study of the cardiovascular effects of therapeutic levels of tricyclic antidepressants had established the relative safety of these drugs even in patients with significant cardiovascular disease. However, recent studies demonstrating a deleterious effect of antiarrhythmic agents in patients with ischemic heart disease have significant implication for conclusions about tricyclic safety. Studies in cardiology designed to demonstrate that suppression of ventricular arrhythmia in the post-myocardial infarction period would reduce mortality produced the unexpected opposite result, i.e., patients treated with class I antiarrhythmic drugs actually had an increase in their mortality rate. Since tricyclics are classified as type IA antiarrhythmics, it would seem prudent to assume that they have similar risks unless proven otherwise. Other drugs such as the serotonin selective reuptake inhibitors or bupropion, which may be safer than the tricyclics from the cardiovascular perspective, have yet to establish their efficacy in the older and more severely depressed patient population.

Age Factors↗
PubMed1993

Smoking cessation, clonidine, and vulnerability to nicotine among dependent smokers.

OBJECTIVE: This study examines the efficacy of clonidine in smoking cessation and the influence of gender, history of major depression, and measures of nicotine dependence. METHODS: The study was designed as a 10-week double-blind randomized comparison stratified for gender and major depression. Three hundred subjects who smoked cigarettes heavily were enrolled in the study. Abstinence from smoking was evaluated by self-report and verified by serum cotinine levels. RESULTS: Gender, major depression recurrent type, and measures of nicotine addiction were risk factors for treatment failure. There was no clonidine effect in men, but there was a modest effect in women (odds ratio, 2.01; 95% confidence interval, 1.00 to 4.10) that was most pronounced (odds ratio, 8.5; 95% confidence interval, 1.67 to 43.62) among women with the highest risks. CONCLUSION: Measures of addiction and major depression predict treatment failure. Together they are stronger predictors of outcome than drug. Clonidine is a limited aid in cessation, and drug effects come primarily from women at high risk for treatment failure. An increased risk for psychiatric complications after smoking cessation was apparent among smokers with histories of major depression, particularly bipolar disease.

Adolescent↗
PubMed1993

Effect of history of alcoholism or major depression on smoking cessation.

The authors examined the influence of a history of alcoholism or major depression on smoking cessation for 220 subjects. The success rate of recovering alcoholics was comparable to that of nonalcoholics, comorbidity of alcoholism and major depression exerted a detrimental effect, and smoking cessation did not precipitate an alcoholic relapse.

Adult↗