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Biomedical subjects

A J Gelenberg

Publications and source records attributed to A J Gelenberg.

At least 91 records · Page 5Linked to original sources
PubMed1984

Tyrosine for the treatment of depression.

The two most widely held biochemical models of depression--the catecholamine (CA) and indoleamine (IA) hypotheses--explain depression as a result of deficient transmission of the CA norepinephrine (NE) or the IA serotonin (5-hydroxytryptamine, 5-HT) respectively. Until recently, all drugs used to treat depression appeared to enhance neurotransmission in one or both of these systems, which was used to explain their antidepressant actions (Gelenberg and Klerman, 1978). In fact, it was this action of antidepressants that gave rise to the models of depression. Another way to increase brain levels of NE and 5-HT, and potentially to increase presynaptic activity, would be the systemic administration of the precursors of the neurotransmitters, an approach something like organic gardening in the brain. For this purpose, the 5-HT precursors tryptophan and 5-hydroxtryptophan (5-HTP), and the NE precursors tyrosine and dihydroxyphenylalanine (DOPA), have been administered to depressed patients. This paper reviews some of the theoretical background and clinical experience with the precursor strategy, focusing primarily on work with L-tyrosine. All four precursors as possible antidepressants have been recently reviewed (Gelenberg, 1982).

5-Hydroxytryptophan↗
PubMed1984

Double-blind comparison of amoxapine and imipramine in the treatment of depressed patients.

A 5-week double-blind study compared amoxapine to imipramine (2:1 dosage ratio) in the treatment of depressed outpatients. The two agents were similar in anti-depressant efficacy and rapidity of action. The most common adverse reactions to both drugs were anticholinergic effects and sedation; cardiovascular effects were minimal. A few amoxapine-treated patients developed adverse effects typical of neuroleptic drugs: some experienced extrapyramidal signs, one developed galactorrhea, and most showed elevated plasma prolactin concentrations. Amoxapine was associated with significant neuroleptic activity in plasma. No correlation was found between blood levels of either drug and therapeutic response.

Adolescent↗
PubMed1984

Use and abuse of anticholinergic drugs in psychiatry.

To some extent, drugs with anticholinergic activity will probably retain a place in our therapeutic armamentarium, along with sedating antihistaminic compounds. However, it looks as if we will soon have available antidepressant drugs that produce few, if any, anticholinergic effects. And among antipsychotic agents, the high-potency drugs have given us a low-anticholinergic option. We have even seen the advent recently of cholinomimetic compounds, such as lecithin, which could have some utility in psychiatric practice. Our hope is that, in the future, a better understanding of cholinergic systems will lead to greater clinical options in treating neuropsychiatric disorders.

Aged↗
PubMed1983

The pharmacologic treatment of schizophrenia: a progress report.

Pharmacologic agents currently used or being studied for the treatment of schizophrenia are reviewed. Neuroleptic medications are still the mainstay of treatment, but recent studies suggest new approaches to dosage and to the treatment of acute psychosis. Lithium is beneficial in psychotic illnesses with acute onset and a remitting course, regardless of the acute psychotic symptoms. Antidepressant agents may ameliorate depression in psychotic patients, but do not improve psychotic symptoms or social withdrawal. Propranolol's reported antipsychotic action has not been confirmed by controlled studies, but the drug may have a role in treating organic psychoses. The benzodiazepines, clonidine, and carbamazepine all merit more investigation as possible treatments for psychosis. The implications of differential treatment response among schizophrenic patients are discussed.

Acute Disease↗
PubMed1982

Development and prediction of postpsychotic depression in neuroleptic-treated schizophrenics.

Data were collected during a year-long multicenter collaborative trial comparing short-acting fluphenazine hydrochloride with long-acting fluphenazine decanoate in a group of schizophrenic patients being maintained in the community. We examined the emergence and course of depressive symptomatology, operationally defined by the Hamilton Depression Scale total score. Of 211 patients, approximately 25% had depression develop within five months after discharge. Depressed patients had a more chronic psychiatric history and, contrary to the hypothesis that depression is a favorable prognostic indicator, they were more likely to relapse. There were no differences in incidence of emergent depression between the two drug treatment groups.

Adolescent↗
PubMed1981

Renal function monitoring in patients receiving lithium carbonate.

As a screening test for renal function, urine concentration was measured following a 12-hour overnight fast in 54 outpatients taking lithium carbonate and 19 patients receiving antidepressant drugs. A significantly greater percentage of lithium patients failed to achieve a maximum urine concentration of 600 mOsm/kg (63% versus 33% in the antidepressant group, p less than .001). This level, a compromise between the sensitivity and specificity of the test, is viewed as a cutoff point for further testing. It is concluded that urine concentration testing is a feasible first-line screen for renal function among lithium-treated patients. Other preliminary studies include routine urinalysis, serum creatinine determination, and estimated creatinine clearance. Second-line testing includes a repeated dehydration test and administration of DDAVP.

Adolescent↗
PubMed1981

The effect of amoxapine and imipramine on serum prolactin levels.

The effect of traditional tricyclic antidepressants on serum prolactin levels is controversial. In a five-week double-blind study of depressed outpatients, imipramine hydrochloride therapy did not lead to any significant change in serum prolactin levels. In contrast, amoxapine, a new antidepressant, produced significant elevations in serum prolactin levels in female and in male patients. Amoxapine may block dopamine receptors in central tuberoinfundibular pathways, which would account for its prolactin-elevating activity. On the other hand, imipramine and other traditional tricyclic antidepressants do not affect dopamine transmission, do not raise serum prolactin levels, and are not effective antipsychotic drugs.

Adult↗