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Biomedical subjects

S Montgomery

Publications and source records attributed to S Montgomery.

At least 91 records · Page 5Linked to original sources
PubMed1979

Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients.

The cardiac effects of amitriptyline, mianserin, zimelidine and nomifensine on the systolic time intervals (STI) and on the high speed surface ECG have been studied in depressed patients. Amitriptyline increased pre-ejection period (PEP) index and the PEP/left ventricular ejection time (LVET) ratio of the STI (P less than 0.05 and P less than 0.02). It also increased heart rate significantly (less than 0.02) and tended to prolong Q-T interval. Mianserin shortened QS2I (P less than 0.05) and LVET (P less than 0.01) and prolonged PEP/LVET ratio (P less than 0.01). Zimelidine did not affect the STI but tended to decrease heart rate and prolong the Q-T interval. Nomifensine decreased T wave height. These findings indicate that amitriptyline decreases cardiac contractility and confirm the quinidine-like action of the tricyclic antidepressants. The changes brought about by mianserin are probably due to effects on the peripheral circulation rather than a direct action on the heart.

Adult↗
PubMed1978

Amitriptyline plasma-concentration and clinical effect. A World Health Organisation Collaborative Study.

54 patients in five centres participated in a study of the relationship between steady-state plasma-levels of amitriptyline (AT) and its active metabolite nortriptyline (NT) and therapeutic response. The participants were inpatients who, after a 7-12 day period of assessment, were rated greater than or equal to 16 on the Hamilton rating scale for depression. They were given 75 mg of amitriptyline for 3 days and then 150 mg daily for an active-treatment period of 6 weeks. Clinical ratings and plasma-samples were obtained at baseline then at 2, 4, and 6 weeks after starting therapy. Contrary to the findings of three previous trials, no important correlations were found between steady-state plasma-levels and therapeutic outcome or corrected side-effects. Corrected side-effects correlated negatively with therapeutic outcome. There seems little advantage in routine monitoring of AT and NT, since variations in plasma-levels do not account for the considerable variation in therapeutic outcome.

Adult↗
PubMed1978

High plasma nortriptyline levels in the treatment of depression. I.

Following a 3-day single-dose kinetic study, 21 moderate to severely depressed inpatients were treated with 100 mg of nortriptyline nightly. Eighteen patients completed the 4-wk trial. The severity of depression was measured by weekly Hamilton Rating Scale and global rating. Blood for plasma nortriptyline estimation was taken at weekly intervals 12 h following the nighttime dose. There was a 6-fold variation in mean plasma nortriptyline levels, ranging from 120 microgram/L to 681 microgram/L. Patients with high plasma levels (greater than 200 microgram/L) showed significantly poorer clinical responses than those with levels in routine treatment, high plasma nortriptyline levels are significantly less effective than intermediate levels. Single-dose pharmacokinetic data obtained on the same patients showed a highly significant correlation with mean steady-state plasma levels obtained, which themselves correlated with clinical response. The value of predicting high plasma nortriptyline levels which are associated with poor response is discussed.

Adult↗
PubMed1978

Reliability of the CPRS between the disciplines of psychiatry, general practice, nursing and psychology in depressed patients.

To test the reliability and robustness of the CPRS in use by different disciplines we obtained 49 pairs of ratings on depressed patients in England and Sweden during treatment. Each rater pair consisted of a psychiatrist trained as a rater plus either a psychologist, a general practitioner, or a nurse, who had not been trained as a rater. The 17 most commonly rated items in depressive illness showed good inter-rater reliability for all groups and demonstrated the robustness of the scale even in training sessions. The implications of this for future interdisciplinary research are discussed along with suggestions for the use of the CPRS for teaching purposes.

Depression↗
PubMed1978

Cross cultural studies on the use of CPRS in English and Swedish depressed patients.

54 English and 52 Swedish patients suffering from primary depressive illness were rated on the full 65 item CPRS scale to examine cross cultural differences. The correlation of the frequencies of items scored in the different patient samples was highly significant (r = 0.88). Of the most commonly scored items (occurring in more than 70% of any of the patient groups) 17 were common to both samples. The three items not in common for the two centres are compared and discussed. The inter rater reliabilities of the Swedish and English teams are compared alongside the inter rater reliabilities of a Swedish rater and an English rater on English patients and are generally good. The remarkable similarity of the psychopathology of primary depressive illness in both cultures and some of the implications are discussed.

Adolescent↗
PubMed1978

Continuation therapy with amitriptyline in depression.

Thirty-two patients who had responded to amitriptyline (150 mg daily) when suffering from a depressive illness were allocated either to receive placebo or to remain on the same medication for one year. Plasma concentrations of the drug were regularly estimated. There was no correlation between plasma concentration and subsequent residual affective morbidity. In spite of considerable encouragement, three of the patients did not take the prescribed amitriptyline and they all relapsed. Five out of sixteen patients who received placebo relapsed. None of the patients who continued to take amitriptyline relapsed. It is emphasized that the patients studied were selected, inasmuch as they were apparent responders to amitriptyline. It is concluded that this group of patients should continue to be treated with antidepressant medication for eight months after apparent recovery, and care should be taken to ensure the patients' compliance.

Adult↗
PubMed1978

Relationship between mianserin plasma levels and antidepressant effect in a double-blind trial comparing a single night-time and divided daily dose regimens.

1. Twenty-six in-patients and 24 out-patients suffering from moderate or severe primary depressive illness were randomly allocated to either a single night-time dose of mianserin 60 mg or a three times daily regimen in a double-blind controlled trial. 2. There was no significant difference in antidepressant effect between the two dosage regimens in either patient group measured using Hamilton Rating Scale (HRS), the Beck Self-Rating Inventory (BSRI) and the new Montgomery and Asberg Depression Scale (MADS). 3. A significant negative correlation (-0.36 P less than 0.05) was found between plasma levels and clinical response using the MADS. A trend for patients with low levels to do worse was also observed suggesting a curvilinear relationship. A highly significant poorer clinical response in patients with levels above 70 microgram/1 was observed using the MADS (t = 3.33, P less than 0.005). This was also seen with the HRS (t = 2.42, P less than 0.02). 4. A significant correlation (r = 0.29, P less than 0.05) with age is reported, and a highly significant increased variability (F = 7.07, P less than 0.001) of mianserin plasma levels in patients over 55 was demonstrated.

Adult↗