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Biomedical subjects

R T Joffe

Publications and source records attributed to R T Joffe.

At least 37 records · Page 2Linked to original sources
PubMed1999

Acute stress increases thyroid hormone levels in rat brain.

BACKGROUND: In experimental animals, exposure to uncontrollable stress induces a number of behavioral and biochemical changes that resemble symptoms seen in human depression and other psychiatric conditions. The present study used a yoked design to examine the effects of uncontrollable footshock stress on brain thyroid hormones in male and female rats. METHODS: Animals in one group received 15 trials where footshock could be terminated by pressing a lever (escapable shock). Rats in a second group received the same amount of shock, but had no control over shock termination (inescapable shock). Control rats received no shock. RESULTS: No significant differences were found among the three groups, for either males or females, in whole brain levels of thyroxine (T4) 3 hours after the footshock session. In contrast, significant group differences in brain levels of triiodothyronine (T3) were found for both males and females. In males, brain T3 was elevated by 21% in the inescapable shock group when compared to controls (p < .012). In females, brain T3 increased by 19% in the escapable shock group when compared to controls (p < .026). Plasma levels of both T3 and T4 were at control levels for all groups. CONCLUSIONS: These results provide the first demonstration that brain T3 levels change rapidly in response to acute stress. The data further suggest that the effects of stress controllability on brain T3 levels may be different for males and females.

Acute Disease↗
PubMed1999

Gabapentin as an adjunctive treatment in bipolar disorder.

OBJECTIVE: To evaluate the efficacy of gabapentin as an adjunctive treatment for bipolar disorder in both depressed and manic phases. METHOD: Thirty seven patients with bipolar type I or II with or without a rapid cycling course were openly treated with gabapentin added to current treatment for up to six months. Mood symptoms were rated weekly for 12 weeks then monthly for 3 months utilizing the HamD and YMS. RESULTS: Participants experienced a significant reduction in both depressive and manic symptoms. CONCLUSIONS: These findings are consistent with others in establishing the efficacy of gabapentin in both phases of bipolar disorder. LIMITATIONS: Small sample size and the use of an open uncontrolled design limit interpretation of results.

Acetates↗
PubMed1999

Rumination and distraction in major depression: assessing response to pharmacological treatment.

BACKGROUND: Response style theory of depression (RST) predicts that individuals who ruminate in response to their depressed mood will suffer an amplification and prolongation of that mood, whereas individuals who engage in distraction responses will alleviate and attenuate their depressed mood. RST has been shown to predict prolonged depression in samples of non-clinical, untreated individuals with mild to moderate depression but has not been tested in samples of depressed patients undergoing treatment. OBJECTIVE: In this preliminary investigation we examined: (1) whether RST predicts non-response to pharmacotherapy with outpatients suffering from major depression, and (2) whether distractive and ruminative responses are associated with clinical variables hypothesized to be associated with them. METHODS: Eighty-nine depressed outpatients being treated with standard antidepressant pharmacotherapy were administered the Response Style Questionnaire, a scale designed to measure rumination and distraction, prior to treatment. RESULTS: Distraction, but not rumination, predicted change in depression severity over the course of treatment and overall treatment outcome. Neither rumination nor distraction was associated with previous number of depressive episodes or duration of current depressive episode. DISCUSSION: These results provide only partial support for RST as a predictor of treatment response. Future investigations are needed to determine if rumination and distraction are predictive of recurrent depressive episodes in recovered depressed patients. LIMITATIONS: As the data in this study was retrieved from a clinical database, the conclusions of this report must be viewed tentatively. Replication with other clinical samples is needed.

Adult↗
PubMed1999

A two-illness model of bipolar disorder.

The current approach to mood disorders is that bipolar disorder, comprising both mania and depression, is a discreet illness distinct from unipolar depression. This formulation has profoundly influenced the approach to understanding the biology and etiology of these disorders, as well as the manner in which the various phases of bipolar disorder are treated. Our new model suggests that bipolar disorder comprises two distinct illnesses, mania and depression, and that bipolar depression is no different from unipolar depression. Studies of clinical syndromes, course of illness, family history and genetics, biological factors, and treatment response data directly or indirectly support this new model.

Antidepressive Agents↗
PubMed1999

Family-of-origin characteristics in bipolar disorder: a controlled study.

OBJECTIVE: To assess the family-of-origin characteristics of patients with bipolar disorder relative to those of control subjects. METHOD: Fifty-six euthymic patients meeting research diagnostic criteria for bipolar disorder and 21 control subjects completed the Family Environment Scale (FES) for the family they grew up with. RESULTS: The 2 groups showed strikingly similar profiles on 10 indices of family functioning or structure. CONCLUSIONS: The results do not support the hypothesis that specific family attributes contribute to the development of bipolar disorder.

Adult↗
PubMed1999

Do depressed subjects who have failed both fluoxetine and a tricyclic antidepressant respond to the combination?

BACKGROUND: Recent evidence suggests that the combination of fluoxetine and desipramine may provide a rapid and effective treatment for depression. METHOD: The current study evaluated 13 subjects with DSM-III-R nonpsychotic major depression who had previously failed either desipramine or imipramine and who were currently unsuccessfully treated with fluoxetine. Desipramine or imipramine was added to fluoxetine and Hamilton Rating Scale for Depression (HAM-D) scores, Beck Depression Inventory (BDI) scores, and plasma tricyclic levels were monitored for 3 weeks. RESULTS: Of the 13 subjects, 7 (54%) had a greater than 40% decline in HAM-D scores and 4 of these (31%) had 50% or greater decline in HAM-D. At week 3, responders (767 +/- 282 nmol/L) had a significantly higher mean tricyclic level as compared with nonresponders (515 +/- 95 nmol/L, F = 25.1, p < .0001), and change in BDI scores was significantly correlated with tricyclic level (r = -0.60, p < .05). CONCLUSION: These findings suggest that in some subjects the positive clinical effect of combining fluoxetine and a tricyclic antidepressant may be related to the plasma levels of the tricyclic compound.

Adult↗
PubMed1998

Impact of suppression of thyroxine on folate status during acute antidepressant therapy.

Antidepressant response is associated with a rise in red cell folate (RCF) and a reduction in thyroxine (T4). Since T4 levels may directly influence folate status, it is possible that the increase in folate with recovery results from the decline in T4. To examine the possible role of thyroid hormones in the observed change in folate status during antidepressant therapy, T4, tri-iodothyronine (T3) or placebo was given in a double-blind fashion to 25 depressed subjects at the initiation of standard antidepressant treatment. Folate levels and mood [using the Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI)] were measured at baseline and following 4 weeks of therapy. Using MANOVA for repeated measures, there was a significant interaction between response status and time for vitamin and hormone levels. Univariate analysis confirmed that response was associated with a significant change in red cell folate, but not a significant change in T4 or T3. The mean change in RCF across the 4-week trial was significantly greater in the 14 responders than the 11 non-responders. Change in RCF, and not change in T4 or T3, was significantly correlated with change in HAMD and contributed significantly to the variance in change in HAMD. These results suggest that change in RCF is closely tied to response to antidepressant treatment, and this effect is not inhibited by exogenous administration of thyroid hormones or the changes in T4 that the exogenous hormones produce. These findings support the possible role of folate, independent of thyroid function, in the modulation of mood.

Adult↗
PubMed1998

Hormonal and subjective responses to intravenous m-chlorophenylpiperazine in women with seasonal affective disorder.

BACKGROUND: There is emerging evidence of serotonergic dysfunction in patients with seasonal affective disorder (SAD). We examined central serotonergic function in female patients with SAD (fall-winter pattern) by means of neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist m-chlorophenylpiperazine. METHODS: Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to m-chlorophenylpiperazine (0.1 mg/kg intravenously) and placebo in 14 unmedicated female patients with SAD in the depressed state and 15 female normal controls. All testing was done in the fall-winter months and during the follicular phase of the menstrual cycle. Plasma prolactin and cortisol levels were used as neuroendocrine measures, while subjective responses were assessed by means of visual analog scales of 10 mood states. RESULTS: On the basis of net responses to m-chlorophenylpiperazine (placebo effects subtracted from drug effects), patients with SAD exhibited blunted prolactin responses and less sadness than normal controls in response to the drug. When order of presentation of drug and placebo was taken into consideration, altered "calm" and "high" responses were also found in the patient group. CONCLUSION: Evidence of dysfunction at or downstream to central serotonergic receptors in female patients with SAD confirms and extends findings from previous research.

Adult↗
PubMed1998

Does the chronological relationship between the onset of dysthymia and major depression influence subsequent response to antidepressants?

OBJECTIVE: To determine whether the chronological relationship between the onset of dysthymia and the onset of the first major depression influences treatment outcome in patients with double depression (DD). METHOD: Clinical and outcome measures previously collected in 77 consecutive outpatients who presented with major depression and who had pre-existing dysthymia (i.e. DD) were reviewed for the current retrospective analysis. Subjects had been administered the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-LV), and the Hamilton Rating Scale for Depression (HAM-D) prior to open antidepressant treatment and after 5 and 12 weeks of therapy. Response was defined as a 50% decline in HAM-D to score +/-8. Subjects were divided into those with the onset of dysthymia before the first major depression (DysB; n = 47), onset of dysthymia after major depression (DysA; n = 12) and those with onset of both condition within 2 years of each other (INDIST; n = 18). RESULTS: There were no significant differences between these three groups in baseline HAM-D. However, DysA subjects had significantly higher mean HAM-D scores than the DysB subjects at week 5 and the INDIST subjects at week 12. Response rates at week 12 were lower in subjects with DysA (33%) as compared with DysB (57%; Fisher's exact test, P = 0.06) and INDIST (78%; Fisher's Exact test P = 0.02). CONCLUSIONS: These findings suggest that the onset of the first episode of dysthymia after the first major depressive episode (i.e. DysA) may adversely affect response to subsequent treatments in patients with DD.

Adolescent↗
PubMed1998

Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores.

BACKGROUND: The importance of gender on the course and outcome in bipolar disorder (BD) has been widely acknowledged. The limited data suggest that the prevalence is similar between sexes but that the course of illness may be different. This study investigated gender differences in a clinic sample of patients with BD including a measure of subjects' perception of well-being and functioning. METHODS: Euthymic outpatients attending a mood disorders clinic were systematically assessed. Measurements obtained included SADS-LV, Hamilton Depression Ratings scores, Young Mania Rating scores, and Medical Outcome Survey Short Form 20 items and Global Assessment of Functioning. RESULTS: Women with BD have a later onset of mania, are more likely to have a rapid cycling course, experience mixed episodes, experience more depressive episodes and report more overall impairment in all MOS subscale scores with significant impairment in physical health and pain. CONCLUSIONS: Further investigation and replication of these differences need to be addressed including non-euthymic patients and during a longer period of systematic follow-up.

Adult↗
PubMed1998

Confirmatory factor analysis of the revised Personal Style Inventory.

The revised Personal Style Inventory (PSI) was developed to measure the sociotropy and autonomy personality dimensions; both of these dimensions are thought to confer specific vulnerabilities to the onset, maintenance, and reoccurrence of depression. Confirmatory factor analysis was used to test the theoretical structure that informed the construction of the PSI. Using a large sample of nonclinical participants (n = 869) and a sample of outpatients with major depression (n = 101), both the items and the subscales of the PSI decomposed into factor structures that were, overall, fair to good representations of the theoretical model. Modifications were needed at the subscale level to achieve an adequate fit for the nonclinical and clinical samples, which provide implications for both the measurement and theory of the PSI and the sociotropy and autonomy domains.

Adult↗
PubMed1998

A large open-label study of venlafaxine in depressed outpatients by community-based physicians.

BACKGROUND: Studies to date suggest that venlafaxine is effective, well tolerated, and safe in a broad spectrum of patients. We examined the clinical utility and tolerability of venlafaxine in patients treated by community-based psychiatrists and family physicians in a naturalistic clinical setting. METHOD: Nineteen physicians each recruited 10 to 20 physicians to enroll 5 patients each maximum, diagnosed with DSM-IV major depression or dysthymia. The patients were at least moderately ill (Clinical Global Impressions) with a score of at least 32 on the Zung Self-Rating Depression Scale. After baseline clinical and laboratory assessments, each patient received 37.5 mg of venlafaxine b.i.d., with adjustments possible at the 5 visits during the next 8 weeks. RESULTS: Of the 880 patients at baseline, 682 completed the 8-week study. The daily doses of venlafaxine ranged between 18.75 mg and 375 mg, with 80% receiving between 75 and 150 mg/day by 8 weeks. The intent-to-treat analysis revealed that at 8 weeks, 62% (522 of 843) of patients were either much or very much improved. Nausea was the most frequent side effect, followed by somnolence, headache, and dry mouth. CONCLUSION: Venlafaxine has good clinical utility and tolerability in a community-based sample of a broad spectrum of depressed outpatients.

Adolescent↗
PubMed1998

The use of thyroid supplements to augment antidepressant medication.

Despite methodological flaws that limit conclusions, a considerable database documents the efficacy of triiodothyronine (T3) as an augmentation strategy for response to various classes of antidepressants. One study suggests that T3 and lithium are of comparable efficacy in antidepressant nonresponders. No clear biochemical or clinical predictors of preferential response to T3 have been found. The role of T3 augmentation requires further evaluation, especially with regard to dose and duration.

Antidepressive Agents↗
PubMed1997

Rapid cycling bipolar affective disorder: lack of relation to hypothyroidism.

Thyroid indices were measured after an extended period of medication-free evaluation averaging 6 weeks in 67 consecutively admitted patients with bipolar illness. Thyroid hormone levels -- thyroxine (T4), free T4 and triiodothyronine (T3) -- were not significantly different in the 31 rapid cyclers (> or = 4 affective episodes/year) than in 36 non-rapid cyclers. Analysis of covariance indicated a non-significant trend relation between higher T4 and a greater number of affective episodes in the year prior to admission and male gender when age was covaried. Several previous reports, primarily in medicated subjects, have suggested a link between rapid cycling patients and decreased peripheral thyroid indices (low hormone levels and elevated TSH), but now the majority of studies do not support such a relation. Among those in the literature, this study includes patients studied for the longest time off medications and further suggests that the commonly-cited relation between subclinical hypothyroidism and rapid cycling bipolar illness be reevaluated.

Adult↗
PubMed1997

Regional changes in beta1 thyroid hormone receptor immunoreactivity in rat brain after thyroidectomy.

Quantitative [125I]protein G-based immunohistochemistry was used to map the distribution of beta1 thyroid hormone receptor (TRbeta1) in normal and thyroidectomized adult rat brain, using a previously characterized polyclonal antibody. The distribution of TRbeta1-like immunoreactivity in normal brain was largely but not perfectly concordant with previous accounts of TRbeta1 mRNA distribution in rat brain. Thyroidectomy resulted in increased immunolabeling in most brain regions (mean increase: 14%, range: -4% to +25%), with statistically significant effects being observed in 9 of the 36 brain regions examined. Brain regions showing the most pronounced effects included the habenular nucleus (+22%), the oriens layer of the hippocampal CA3 region (+24%), and the lateral geniculate nucleus of the thalamus (+23%). These results demonstrate that the TRbeta1 protein in brain is capable of plastic changes in response to adult-onset alterations in TH levels. The observed pattern of brain regional receptor changes following thyroidectomy may provide clues for functional effects of thyroid function alterations in adults.

Age Factors↗