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Biomedical subjects

J T Apter

Publications and source records attributed to J T Apter.

At least 19 recordsLinked to original sources

Buspirone: future directions.

The Food and Drug Administration approved the use of buspirone for generalized anxiety disorder (GAD) in 1986. Since then, numerous studies have examined the efficacy and safety of buspirone for patients with not only generalized feelings of anxiety, but also panic disorder, major depressive disorder, obsessive-compulsive disorder, body dysmorphic disorder, social phobia, posttraumatic stress disorder, selective serotonin reuptake inhibitor-induced adverse events, dementia, behavioral disturbances, attention deficit-hyperactivity disorder, and tobacco dependency. Although relatively few placebo-controlled trials have been conducted on patients with problems other than GAD, an ever-growing body of research suggests future directions for the use of buspirone. This article reviews the body of research relating to new uses for buspirone.

Anti-Anxiety Agents↗

Fluoxetine treatment of patients with major depressive disorder who failed initial treatment with sertraline.

BACKGROUND: This study was conducted to determine if patients with major depressive disorder who had previously failed treatment with one serotonin selective reuptake inhibitor (SSRI) would respond to a different SSRI. METHOD: Adult outpatients (N = 106) with DSM-III-R major depressive disorder and a history of either intolerance (N = 34) or nonresponse (N = 72) to treatment with sertraline were treated with fluoxetine (mean dose = 37.2 mg/day) in a standardized, open-label, 6-week clinical trial. Outcome was assessed at each visit using the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI-Improvement and CGI-Severity) scales, and the Patient's Global Improvement (PGI) scale. RESULTS: Ninety-one patients (86%) completed the study. Sixty-seven patients (63%) responded to fluoxetine (i.e., experienced > or = 50% reduction in HAM-D28 total score at endpoint versus baseline). In addition, clinically and statistically significant improvements were noted on all measures of depressive symptoms and global functioning. There was a nonsignificant trend for patients with a history of less vigorous sertraline trials to respond more favorably to fluoxetine. Fluoxetine therapy was generally well tolerated, and there were only slight differences in adverse events reported by patients who had been intolerant to sertraline versus those who were nonresponders. CONCLUSION: These findings indicate that fluoxetine and sertraline, two widely used SSRIs, are not interchangeable. Patients who either have had trouble tolerating or have not responded to sertraline may do well on fluoxetine treatment.

1-Naphthylamine↗

Possible selves in major depression.

Ratings of possible selves and resultant self-concept discrepancies were examined in 25 patients diagnosed with major depression and 25 control subjects. Self-concept discrepancies significantly discriminated patients from controls. The presence of negative features in the self-schema was a stronger indicator of depressive symptomatology than was the absence of positive self-appraisal. Depressives' future projections of self were less pessimistic than predicted by cognitive theories of depression.

Adult↗

The oral dose-effect relationship for fluvoxamine: a fixed-dose comparison against placebo in depressed outpatients.

This 7- to 8-week, multicenter, randomized, double-blind, placebo-controlled study was performed to determine the dose-effect relationship and minimum effective dose for fluvoxamine maleate in a titrated fixed-dose study of major depressive disorder. Gradual titration over 2 weeks to fixed maintenance doses was employed to minimize dropout due to initial side effects. The study enrolled 600 outpatients, male and female, age 18-65, meeting DSM-III-R criteria for major depressive disorder. A 13-item subscore of the standard 21-Item Hamilton Depression Scale was used to minimize the possible contribution of known side effects from serotonin reuptake inhibitors to the overall HAM-D score. Secondary efficacy assessments included the HAM-D retardation factor, HAM-D depressed mood item, CGI-severity of illness item, and SCL depression factor. Fluvoxamine (50-150 mg/day) was therapeutically effective and well tolerated during 6 weeks of therapy. Based on the HAM-D depressed mood item, efficacy was dose dependent. The minimum effective dose was 50 mg/day. Fluvoxamine maleate shows dose-related effectiveness in the acute treatment of major depressive disorder.

Administration, Oral↗

Bupropion/nortriptyline combination for refractory depression.

Many patients fail to respond to one or more trials with a single antidepressant. In such cases polypharmacy is often necessary and beneficial, although there may be an increased risk of complications. Four case reports are presented of patients with refractory depression treated successfully with the combination of the tricyclic antidepressant nortriptyline and the newer agent bupropion.

Bupropion↗

Frontiers in biological psychiatry: new drug development.

This past decade has been a fertile time for new drug developments for the central nervous system. This article discusses cutting edge treatments for depression, anxiety, and psychosis. Some of these medications now are approved; many still are being researched.

Anxiety Disorders↗

Side Effects and toxicity of lithium.

Although lithium remains the most specific treatment for bipolar affective disorder, it should be cautiously prescribed and used only when clinically indicated. The main indications for lithium are the manic phase of bipolar affective disorder and prophylaxis of both manic and depressive episodes. Lowering serum lithium levels will markedly reduce the incidence of side effects, and patients should be maintained at the lowest possible serum level. The serum level may be as low as 0.4 mEq/L and as high as 1.5 mEq/L, depending on the clinical response of the patient and the presence of side effects. The most controversial areas are the possibility of renal toxicity and the concomitant use of lithium with neuroleptics, especially haloperidol.

Antipsychotic Agents↗