Influence of fluoxetine on plasma levels of desipramine.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to P J Goodnick.
Explore the source record for details and available documents.
Calmodulin-activated calcium ATPase is a transport enzyme which establishes the normal level of intracellular ionized calcium in most cells. We have determined values for three parameters of this enzyme: E-t, the concentration in the membrane; Vmax, the maximal velocity, and Ka, the binding affinity for calmodulin. We assayed these parameters in erythrocyte membranes from lithium carbonate-treated bipolar subjects and from normal controls. Bipolar subjects have significantly increased levels of E-t compared with normal controls.
A prospective 1-year study was conducted in 69 patients with affective disorder. Despite remission, there was a significant continued presence at each visit of major symptoms of mania and depression and of mean mood shift. Furthermore, sub-clinical affective symptoms, as determined by General Behavior Inventory self-rating scores completed at 4 month intervals, continued at a level throughout the entire year significantly higher in patients than in 14 normal controls. Finally, as expected, presence of subclinical symptoms on the GBI correlated significantly with presence of major symptoms and mood shift. Correlation varied from 0.55 to 0.61; all significances were less than 0.001.
Forty-two patients with a history of affective disorder on lithium prophylaxis alone participated in a prospective 1-year study of inter-episode symptoms. Despite expected significant differences in mean plasma lithium level in patients, those with mean levels above the median (0.82 +/- 0.10 mEq/l) did not differ in incidence of major symptoms per visit, in mood shift per visit, or in rate of subclinical symptoms on the General Behavior Inventory from those patients with mean level below the median (0.52 +/- 0.09 mEq/l).
For 98 affective disorder patients receiving lithium prophylaxis for a mean of 45 months, number of interepisode symptoms correlated with relapse rate. Response to prophylaxis appeared highly determined by prelithium frequency of episodes and duration of lithium treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A 6-week double-blind trial of fluoxetine treatment of unipolar major depressive disorder in 49 patients was evaluated in terms of improvement in the Hamilton Depression Rating Scale (HDRS) and Clinical Global Improvement (CGI) scores. A relationship was found between change in HDRS (absolute and percentage decrease from baseline) and final CGI ratings. However, because of a few placebo-responders, endpoint analysis with both the HDRS and CGI showed no differences between active drug and placebo. Pattern analysis of persistent response did successively separate active drug from placebo (less than 0.05).
A new self-rating scale, the General Behavior Inventory (GBI), was lower in eight controls and 61 patients in remission than in 32 depressed patients. Scores of depressed patients decreased over treatment time. GBI score correlated significantly with the past occurrence of manic plus depressive symptoms per visit and past mean mood shift per visit.
Seventy patients with unipolar major depressive disorder were treated with fluoxetine or placebo in a 6-week double-blind trial and were evaluated by changes in scores on the Hamilton Rating Scale for Depression (HAM-D) and the global improvement measure of the Clinical Global Impressions (CGI) scale. High correlations were found between the changes in HAM-D scores from baseline to endpoint and the final CGI improvement ratings. In patients with moderate depression (baseline HAM-D score of 20 or more), the differences in endpoint analysis between active treatment and placebo groups were significant. A persistent pattern of improvement was noted in 27% of those receiving fluoxetine but in none of those receiving placebo. Physician and patient evaluations as determined by the improvement measure of the CGI were closely correlated.
Twelve patients who met Research Diagnostic Criteria for a history of bipolar affective disorder gave informed consent for open discontinuation of lithium therapy for 3 weeks. There was no significant change after lithium discontinuation in the number of depressive or manic symptoms, in mood score, in total Zung Depression score, or in any of the 20 items found in the Zung Depression scale. There were significant reductions in total severity of side effects, and improvement in the three side effects reflecting renal function: polydipsia, polyuria, and nocturia. These changes were reflected in the significant increase in urine specific gravity. Significant changes in side effects did not take place until at least 2 weeks after lithium was discontinued. Other significant relationships were found between increases in serum thyroid hormone levels and in urine specific gravity, and decreases in Vmax of platelet serotonin uptake and increases in degree of clonidine-induced hypotension.
There were no differences in interepisode functioning or side effects between bipolar patients (N = 44) with plasma lithium levels above the median and those with levels below the median. Low levels were able to stabilize mood and individual symptoms for 40.5 months.
Studies that compare the treatment response of patients diagnosed as primary affective disorder or schizoaffective disorder are reviewed. Although relatively few controlled or uncontrolled studies of the chemotherapy of schizoaffective disorders have been conducted, available evidence suggests that: (1) lithium carbonate is effective in the initial treatment of both schizoaffective mania and mania; (2) antidepressants alone, neuroleptics alone, or their combination can be effective in the initial treatment of both schizoaffective depression and primary depression; and (3) prophylactic administration of lithium carbonate may reduce the frequency and duration of relapse in both schizoaffective manic and schizoaffective depressed patients. Thus, treatment studies indicate that the schizoaffective disorders are very similar to the primary affective disorders with regard to response to pharmacologic treatment. Evidence from this laboratory that schizoaffective manic patients respond more slowly than manic patients to lithium or neuroleptic treatment is presented.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.