A controlled trial of phenelzine in bulimia.
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Adult↗
Biomedical subjects
B T Walsh
Publications and source records attributed to B T Walsh.
Nortriptyline in depressed patients with left ventricular impairment.
Previous studies of the effect of tricyclic antidepressants on left ventricular function in depressed patients with moderate to severe ventricular impairment have focused primarily on imipramine hydrochloride. In a prior study, we found that although imipramine had no effect on ejection fraction as measured by first-pass radionuclide angiography, the treatment could not be tolerated by 50% of the patients because of intolerable drug-induced orthostatic hypotension. Nortriptyline hydrochloride is an effective antidepressant that, in depressed patients without heart disease, causes significantly less orthostatic hypotension than imipramine. To see if this advantage could be safely extended to patients with congestive failure, we measured the effect of nortriptyline on ejection fraction and blood pressure in 21 depressed patients with left ventricular impairment. Ejection fraction was unchanged by nortriptyline treatment, and orthostatic hypotension developed in only one (5%) of 21 patients. Nortriptyline emerges as a relatively safe treatment for depression in patients with left ventricular impairment.
Aged↗
Laboratory studies of eating behavior in women with bulimia.
This report describes a standard procedure for studying the disordered eating behavior of bulimic patients in a laboratory setting. Test meals were given to eight normal weight women with bulimia under four different conditions on non-consecutive days. On day 1 they were asked to consume as much as they "would normally eat" by means of a straw from an opaque container holding 1500 g of a palatable liquid food. An eating monitor recorded the pattern of consumption. Five patients showed abnormalities of either excessive eating or acceleration of the rate of eating. On the second and third days they were given standardized amounts of an array of foods. They were instructed to eat normally on one of these days and to eat as much as they could on the other, in counterbalanced order. All patients ate to excess when they were asked, over a 28 to 90 min period, and consumed a mean of 4477 kcal (range 2083-8499 kcal) with a macronutrient composition similar to that of the typical American diet. They all vomited afterwards. On the day they were asked to eat normally, five patients overate and vomited, two ate very little, and one refused to participate. On the fourth day patients were asked to eat as much as they could of a single item, ice cream. Six patients consumed a mean of 1545 kcal (range 741-2919 kcal); one patient ate only 85 kcal; and one patient refused to participate. There were large and significant correlations among the sizes of the various meals consumed in excess.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Tricyclic nonresponders: phenomenology and treatment.
In an attempt to identify characteristics of tricyclic antidepressant nonresponders, the authors reviewed the records of inpatients with unipolar, nondelusional depression who had received adequate treatment (confirmed by plasma level determination) with tricyclics. The 17 patients who failed to respond were compared to a group of tricyclic responders with respect to demographic and phenomenologic variables. Although the nonresponders tended to have more previous episodes of depression and higher anxiety scores on the pretreatment Hamilton scale than the responders, they could not be distinguished from the responders by clinical or demographic data. All of the patients who failed to respond to tricyclics subsequently responded to monoamine oxidase inhibitors and/or ECT.
Antidepressive Agents, Tricyclic↗
Medication in the treatment of bulimia.
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Adolescent↗
EEG-monitored sleep in anorexia nervosa and bulimia.
We compared the EEG-monitored sleep of 8 women with anorexia nervosa and 16 normal weight women with bulimia to that of 14 normal women. The patients with anorexia nervosa spent less time asleep and spent less of their sleep time in Stage 1. The sleep of the normal weight patients with bulimia was remarkably similar to that of the controls. These data suggest that most patients with anorexia nervosa and bulimia do not exhibit the type of sleep disturbances characteristic of patients with major depressive illness.
Adult↗
A double-blind trial of phenelzine in bulimia.
Thirty normal weight women with bulimia completed a double-blind, placebo-controlled trial of phenelzine sulfate. The results demonstrate a significant therapeutic advantage for phenelzine over placebo. Preliminary data suggest that phenelzine may be of benefit even to non-depressed patients with bulimia.
Adolescent↗
The dexamethasone suppression test in bulimia.
Nineteen (35%) of 55 women with bulimia failed to exhibit cortisol suppression after dexamethasone administration. Although there was no statistically significant difference between suppressors and nonsuppressors on any clinical variable, there was a higher frequency of major depression among nonsuppressors.
Adult↗
Acute psychosis following phenelzine discontinuation.
Most concern over the untoward effects of monoamine oxidase inhibitors (MAOIs) has concentrated on the hypertensive crises and recently on orthostatic hypotension, hypomania, and sexual dysfunction. However, little has been written about withdrawal effects when MAOIs are discontinued. This article reports an acute organic psychosis marked by visual, auditory, and tactile hallucinations after abrupt discontinuation of phenelzine in two young women without previous history of psychotic symptoms.
Acute Disease↗
Cigarette craving, smoking withdrawal, and clonidine.
Clonidine, an alpha-2-adrenergic agonist, significantly reduces opiate withdrawal. Fifteen heavy smokers abstained from cigarettes on three separate occasions and received instead clonidine, placebo, or the benzodiazepine alprazolam. Clonidine and alprazolam diminished withdrawal symptoms. The two drugs suppressed anxiety, tension, irritability, and restlessness equally but clonidine had a greater effect than alprazolam on cigarette craving. These observations suggest that noradrenergic activity is a common feature in the pathophysiology of withdrawal and that a special relationship exists between central noradrenergic activity and craving.
Adult↗
Treatment of bulimia with phenelzine. A double-blind, placebo-controlled study.
Twenty bulimic women of normal weight participated in a double-blind trial studying the effects of a monoamine oxidase inhibitor (MAOI). Nine women received phenelzine sulfate and 11 received placebo. Although phenelzine's side effects were a problem, the phenelzine-treated patients reported significantly fewer binges per week and had a lower Eating Attitudes Test score. Five of the nine phenelzine-treated patients ceased binging entirely and the other four reduced their binge frequency by at least 50%; none of the 11 placebo-treated patients stopped binging and only two reduced their binge frequency by 50% or more. These data demonstrate that phenelzine is significantly more effective than placebo in the treatment of bulimic women of normal weight and suggest a place for MAOIs in the treatment of bulimic patients capable of maintaining a tyramine-free diet.
Adolescent↗
Sleep and growth hormone secretion in women athletes.
Six women athletes underwent 24 h multiple sampling studies with electroencephalographic monitoring of sleep for the assessment of growth hormone secretion and sleep pattern. The athletes tended to have more stage 4 sleep, less REM activity and a similar REM density compared to 5 normal women. The nocturnal secretion of growth hormone was elevated in the first hour following sleep onset in the athletes but was otherwise not statistically different from that of the controls. As all but one of the women athletes had exercise-related menstrual irregularities, the findings reported may be associated with exercise amenorrhea.
Adult↗
Is there a relationship between eating disorder and affective disorder? New evidence from sleep recordings.
There is evidence that patients with anorexia nervosa (particularly those who also have bulimia) and patients with affective disorder share many features. The authors present sleep polygraph data from 20 young women with anorexia nervosa (17 also bulimic) and 10 age-matched normal women. Their urinary free cortisol levels were determined, and the subjects with eating disorders were also rated for depression. The findings suggest the existence of a subgroup of patients who show sleep abnormalities, in addition to clinical and possibly endocrine abnormalities, that indicate concurrent affective disorder. The authors present several models that could account for this relationship.
Adult↗
An open trial of MAO inhibitors in bulimia.
Twelve bulimic women with prominent depression and anxiety were treated with monoamine oxidase inhibitors (MAOIs). A dramatic response was seen in 10 cases. The implications of this open clinical trial for the understanding and treatment of bulimia are discussed.
Adolescent↗
Imipramine-induced inappropriate ADH secretion.
This case demonstrates the occurrence of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in association with the administration of several antidepressant medications. The SIADH was shown by rechallenge to be associated with imipramine, an antidepressant not previously associated with SIADH. In addition, SIADH appeared to occur with bupropion, a new antidepressant structurally dissimilar to tricyclic antidepressants.
Aged↗
The use of imipramine in depressed patients with congestive heart failure.
Previous studies of left ventricular performance (LVP) in depressed patients receiving tricyclic antidepressants have been performed on patients without severe heart disease. This study reports the effect of imipramine hydrochloride on LVP, assessed by radionuclide angiography, in a group of depressed patients with notable preexisting left ventricular dysfunction. Ejection fraction was measured at rest by first-pass radionuclide angiography before and after treatment with imipramine. Ejection fraction was unchanged during treatment, but seven of 15 patients experienced orthostatic hypotension of such severity that administration of the drug had to be discontinued. Plasma concentrations of the drug were essentially twice those usually seen. It is important to appreciate that although imipramine does not further impair resting LVP, this does not mean it is without risk. The physician must watch carefully for orthostatic hypotension when using imipramine in depressed patients with impaired LVP.
Aged↗
Link between bulimia and depression unclear.
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Antidepressive Agents↗
Depression, delusions, and suicide.
A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period was carried out. The authors retrospectively assigned diagnoses according to Research Diagnostic Criteria and DSM-III and found that among the patients who committed suicide there were 14 with unipolar endogenous depression. Of those 14 patients, 10 were considered delusional or probably delusional. In comparison, a control group of similarly diagnosed depressed patients taken from the same institution over the same time period included far fewer delusional depressions. Thus, there was a significant association between delusions and suicide: A delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.
Delusions↗