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Biomedical subjects

F Quitkin

Publications and source records attributed to F Quitkin.

At least 19 recordsLinked to original sources
PubMed1999

Fluoxetine efficacy in menopausal women with and without estrogen replacement.

UNLABELLED: A gradual decline in estrogen levels after the age of 40 may contribute to a higher rate of depression in women over 45 years of age. Estrogen replacement therapy (ERT) has been shown to produce cognitive and mood-enhancing effects in women and may facilitate antidepressant activity. METHODS: We examined the efficacy rates in women on ERT > or = 45 years (n = 40) compared to women > or = 45 years not on ERT (n = 132) and to women < 45 years (n = 396) and to men (n = 262) with major depression during fluoxetine 20 mg daily up to 8 weeks. Remitters with a HAM-D17 score < or = 7 from week 9 to 12 were then treated up to 1-year in a placebo-controlled, relapse-prevention trial. RESULTS: Efficacy rates were similar in women > or = 45 years on ERT when compared to women > or = 45 years taking fluoxetine alone, and when compared to women < 45 years and men taking fluoxetine. A Kaplan-Meier survival analysis in fluoxetine responders treated up to 26 weeks showed a somewhat greater relapse rate in women > or = 45 years taking ERT compared to other treatment groups (P < 0.06). LIMITATIONS: This study was retrospective nature and ERT was given in an uncontrolled fashion: 63% of women received estrogen alone while 37% also took intermittent progesterone. Other variables include the absence of hormonal documentation of menopausal status, no direct assessment of ERT compliance and the use of fixed-dose fluoxetine 20 mg daily. CONCLUSION: In contrast to prior reports suggesting that ERT may facilitate antidepressant activity, we observed similar efficacy in depressed women > or = 45 years taking fluoxetine plus ERT compared to those taking fluoxetine alone.

Antidepressive Agents, Second-Generation↗
PubMed1998

Safety of abrupt discontinuation of fluoxetine: a randomized, placebo-controlled study.

Selective serotonin reuptake inhibitors may be associated with new adverse events after abrupt discontinuation. Hypothesizing that the long half-life of fluoxetine would be protective, this study analyzed the effects of abrupt fluoxetine discontinuation during a randomized, double-blind, placebo-controlled study of depression maintenance treatment. After 12 weeks of fluoxetine treatment (20 mg/day), 395 responders were abruptly randomized to placebo (N = 96) or to continued fluoxetine (N = 299). Patients were seen at weeks 1, 2, 4, and 6 after randomization. Reports of new or worsened adverse events were similar for both groups at each visit after randomization. Patient discontinuations related to adverse events were also similar in both groups. Mild, self-limited lightheadedness or dizziness occurred in a small percentage of patients who discontinued fluoxetine treatment but was of little clinical significance. No cluster of symptoms suggestive of a discontinuation syndrome was observed. Abrupt discontinuation of fluoxetine treatment was well tolerated and did not seem to be associated with significant clinical risk. Fluoxetine may offer a potential safety advantage over shorter-acting agents with respect to treatment interruption and/or discontinuation and may be a better choice for those patients who are likely to miss doses because of travel or forgetfulness.

Adult↗
PubMed1994

Antidepressant treatment in methadone maintenance patients.

We review the controlled trials of antidepressant treatment in methadone patients. Several studies show antidepressant effects, but none demonstrate clear improvement in drug abuse. This is contrary to "self-medication" but rather suggests depression is either independent or substance induced. Methodologic limitations are noted, especially reliance on cross-sectional mood assessment, which may select transient mood disturbances rather than true affective disorder. We review our previously published pilot study of imipramine in depressed methadone patients selected by lifetime history, and we report four year treatment course in the nine patients who responded favorably during that trial. Patients remained euthymic during imipramine treatment and relapsed to depression during attempts to taper it. This suggests imipramine had an enduring antidepressant effect. However, intermittent drug use remained a problem for several patients, suggesting depression and drug abuse are at least in part independent disorders. Placebo controlled replications, combinations of antidepressant medication with psychosocial interventions, and exploration of antidepressants as adjuncts in methadone detoxification, are suggested avenues for further research.

Adult↗
PubMed1993

Social networks and methadone treatment outcome: the costs and benefits of social ties.

OBJECTIVE: This study assessed the impact of social ties on substance abuse treatment outcome. Two models which predict alternative hypotheses were evaluated. 1) Based on the self-medication model, it was hypothesized that social support would aid in coping with painful affect and decrease the need for drugs. 2) Based on a social learning model, it was hypothesized that drug use in the social network would threaten abstinence due to modeling and conditioning effects. METHOD: Seventy methadone maintenance patients were given baseline measures of mood, stress, social support, and drug use in the network and followed prospectively for 3 months with weekly urine drug screens. RESULTS: Social support was correlated with positive affect (r = .59, p < .001), and stress with negative affect (r = .46, p < .001), but no measures of social support, affect, or stress correlated with the proportion of drug positive urines. However, patients with at least one drug user among the closest significant others had 63 +/- 38% positive urines versus 35 +/- 36% positive among those without a drug-using significant other (t = -3.2, p < .002). CONCLUSIONS: Substance use in the social network had a substantial negative impact on treatment outcome. Consistent with the social learning model and the traditional "persons, places, and things," this suggests interventions should get drug-using significant others into treatment and teach patients coping skills to reduce their negative influence.

Adult↗
PubMed1990

Cholinergic REM sleep induction in atypical depression.

The arecoline REM induction test, a measurement of central cholinergic sensitivity, was performed in 10 patients with atypical depression. Arecoline induced REM sleep significantly more rapidly than placebo. Atypical depressives without evidence of anxiety, in particular those without panic attacks, had a more rapid REM induction response to arecoline than atypicals with anxiety symptoms. We compared our atypical depressives with normal controls and affectively ill patients studied in other laboratories. The rapid REM induction response observed in atypical depressives without anxiety was comparable to that seen in endogenous depressives and euthymic bipolars. Previous studies have demonstrated the presence of cholinergic supersensitivity in the latter two groups of patients. Our results suggest that atypical depressives may be distinguished in their response to arecoline based on their anxiety history, and that cholinergic supersensitivity is present in atypical depressives without anxiety. Additional studies with larger samples and simultaneously studied control groups are necessary to test these preliminary findings.

Adolescent↗
PubMed1989

MAOIs and hypertensive crises: the role of OTC drugs.

The authors report several cases showing that use of over-the-counter (OTC) medications containing decongestants can cause hypertensive reactions in patients who are treated with monoamine oxidase inhibitors. Patient instructions accompanying OTC products (particularly those containing phenylpropanolamine) often omit specific warnings about the dangers of those products' concomitant use with MAOIs. Of further concern is the opportunity for patients to be confused by the similarity in names between some prohibited combination products and other more pharmacologically innocuous products that are acceptable for concomitant use.

Adult↗
PubMed1988

Diurnal and circannual variation in platelet 3H-imipramine binding: comparative data on normal and affectively ill subjects.

Using a cross-sectional design, we examined the diurnal and circannual variation in platelet 3H-imipramine binding in 33 patients with bipolar affective disorder, 34 patients with unipolar affective disorder and 58 normal controls. There was no evidence for statistically significant diurnal or circannual variation in the binding parameters in any of the diagnostic categories.

Adult↗
PubMed1988

Panic disorder and depression in female alcoholics.

Eight (32%) of 25 alcoholic women on an inpatient detoxification unit met modified DSM-III criteria for panic disorder, 2 (8%) of 25 met criteria for depressive illness, and 7 (28%) of 25 met criteria for both disorders. These findings replicate the findings of other recent studies and lend preliminary support to the self-medication model of alcoholism.

Alcohol Drinking↗
PubMed1987

Platelet 3H-imipramine binding and familial transmission of affective disorders.

We studied platelet 3H-imipramine binding and family history of affective illness in 26 patients with bipolar affective disorder and 24 patients with unipolar affective disorder. The density of platelet 3H-imipramine binding sites (Bmax) was significantly lower in bipolar patients with family history of affective illness than in healthy controls; however, there was a considerable overlap in Bmax values between the familial cases and the normal controls. A similar trend was observed in familial cases of unipolar disorder but the differences fell short of statistical significance. The nonfamilial cases of affective disorder did not differ from the healthy controls. The possible role of reduced platelet 3H-imipramine binding as a genetic vulnerability 'marker' in affective disorder was discussed.

Adult↗
PubMed1986

Platelet [3H]imipramine binding in affective disorders: trait versus state characteristics.

Platelet [3H]imipramine binding (Bmax) was determined in 67 patients with major affective illness (33 euthymic bipolar, 34 depressed unipolar) and 58 normal control subjects. Bipolar patients had significantly lower Bmax values than did control subjects. The mean Bmax in the unipolar patients was lower than in the control subjects, but the difference was not statistically significant. Dissociation constant (Kd) values did not distinguish patients in either category from control subjects. The significantly lower Bmax in euthymic bipolar patients and the apparent state independence of Bmax in some but not all unipolar patients suggest that platelet imipramine binding may be a trait marker in a subset of affective disorders.

Adult↗
PubMed1986

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↗
PubMed1986

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↗
PubMed1985

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↗
PubMed1985

Auditory laterality in depression: relation to circadian patterns and EEG sleep.

Unmedicated endogenous (ED) and nonendogenous depressed (ND) patients were tested in the morning and evening on a dichotic click detection task and a dichotic consonant-vowel (CV) discrimination task. The ED and ND groups showed a morning to evening shift in lateral asymmetry for detecting dichotic clicks, which was opposite in direction to that previously seen for normal subjects. In contrast, there was no morning to evening shift in asymmetry for dichotic CV discrimination. Lateral asymmetry for dichotic click detection was significantly correlated with EEG sleep characteristics (sleep latency, REM period latency, REM time) and ratings of diurnal variation on the Hamilton Depression Scale. A reversal of the normal lateral asymmetry in the morning was associated with lengthened sleep latencies and with clinical ratings of diurnal variation.

Adult↗
PubMed1984

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↗