Reduced clonidine rapid eye movement sleep suppression in patients with primary major affective illness.

Clonidine hydrochloride, administered intravenously (2 micrograms/kg) during the second non-rapid eye movement period, was significantly less suppressant of rapid eye movement sleep in 10 depressed patients with primary major affective illness, according to Research Diagnostic Criteria, than in three groups of matched subjects (10 normal controls, 10 patients with minor depression, and 10 patients with generalized anxiety). These results suggest that depressed patients with major primary affective illness have down-regulated alpha 2-adrenergic receptors. These findings are consistent with the cholinergic-aminergic balance hypothesis of depression and support the aminergic side of the concept. Finally, the rapid eye movement sleep response to clonidine could provide a new biological marker of affective illness.

Effects of gender and diagnosis on growth hormone response to clonidine for major depression: a large-scale multicenter study.

OBJECTIVE: The authors' goal was to establish, in a large multicenter sample of patients classified according to gender and menopausal status, if the growth hormone (GH) response to clonidine discriminated patients with episodes of major depression from patients with episodes of minor depression. METHOD: The GH response to intravenous clonidine administration (150 micrograms) was compared in 71 male and 140 female patients with major depressive episodes and 47 male and 53 female patients with minor depressive episodes. These patients were diagnosed according to Research Diagnostic Criteria. RESULTS: Differences in the GH response to clonidine between diagnostic groups occurred only between male patients. These results were found in the group as a whole and in each center. The GH responses to clonidine of premenopausal women differed significantly from those of postmenopausal women in each diagnostic group. CONCLUSIONS: These results confirm that gender and menopausal status are of the utmost importance in the interpretation of the clonidine GH test.

Relationship between schizoaffective illness and affective disorders or schizophrenia. Morbidity risk and genetic transmission.

Schizoaffective illness has either been linked to schizophrenia and to affective disorders, or it has been considered to be as separate entity. Family and linkage studies can provide data regarding genetic factors in the aetiology of schizoaffective illness. Morbidity risks for affective illnesses and schizophrenia were estimated in the first-degree relatives of schizoaffective probands as compared to matched controls (bipolars, unipolars and schizophrenics). Linkage studies with X-chromosome markers (protanopia and deuteranopia) were also performed in informative families. Our genetic results indicate that schizoaffective illness is a heterogeneous entity. This syndrome appears to be primarily related to the affective disorders, but there may be a subgroup linked to the schizophrenic spectrum disorders. Our studies also indicate that some schizoaffective syndromes may be transmitted through the X-chromosome, a pattern previously demonstrated in some families with bipolar manic-depressive illness.

Persistent cortisol non-suppression after clinical recovery predicts symptomatic relapse in unipolar depression.

We assessed the length and the quality of remission of 13 unipolar endogenous depressed patients, DST non-suppressors before treatment, in a 2-year prospective study. During this period, we recorded stressful life events. Persistent dexamethasone non-suppression, after treatment and complete clinical recovery, correlated highly with early clinical relapse. All six non-normalizers but only one normalizer were rehospitalized within the following 2 years for a major depressive relapse. Persistent DST non-suppression was unrelated to any impact of drug discontinuation, the occurrence of stressful life events or the length of illness-free intervals in the patient's prior course of illness. Persistent DST non-suppression appears to have significant prognostic value.

Plasma and urinary cortisol levels after dexamethasone in affective disorders.

The validity of the dexamethasone suppression test was evaluated for the differential diagnosis of primary and secondary depressions. Forty hospitalized psychiatric patients (14 primary depressed, 15 secondary depressed and 11 non-depressed controls) were studied. The Research Diagnostic Criteria of Spitzer et al. (1978) were used to classify these patients. Eight out of the 14 primary depressed patients had an abnormally high plasma cortisol at 4 p.m. after dexamethasone. Only 2 out of the 15 secondary depressed patients and none of the 11 controls had an abnormal response to dexamethasone. Based on these results, the dexamethasone suppression test has a sensitivity of 57%, a specificity of 87% and a predictive value of 80%. The determination of urinary free cortisol excretion does not improve the performance of the test.

Efficacy of the 'clonidine REM suppression test (CREST)' to separate patients with major depression from controls; a comparison with three currently proposed biological markers of depression.

We have shown that clonidine, infused i.v. during the second non-REM period, was significantly less REM sleep suppressant in depressed patients than in control subjects. We have named this procedure the 'clonidine REM suppression test (CREST)'. In this report, we compare in the same sample (15 patients with primary major affective illness, 10 normal controls, 15 patients with minor depression and 15 patients with generalized anxiety) the efficacy of the CREST to separate the major depressed patients from the control subjects with the efficacy of three currently proposed biological markers of depression, i.e., the latency of REM sleep, the dexamethasone suppression test and the clonidine growth hormone stimulation test. We found that the CREST had the highest efficacy and suggest that further studies with independent and larger samples of patients and controls are needed to confirm those preliminary results and establish if the CREST could provide a new biological marker of major affective disorders.

Mirtazapine is more effective than trazodone: a double-blind controlled study in hospitalized patients with major depression.

Two hundred hospitalized patients with DSM-III diagnosis of moderate to severe major depressive episode were randomized to receive mirtazapine or trazodone for 6 weeks in a double-blind trial. The dosages were 24-72 mg/day for mirtazapine and 150-450 mg/day for trazodone. The improvement on all depression rating scales used was generally greater for mirtazapine, with statistically significant differences over trazodone in the Hamilton Psychiatric Rating Scale for Depression total score and two subscores (the Bech melancholia factor and retardation factor), the Brief Psychiatric Rating Scale total score, the General Psychiatric Impression Global Assessment Scale, the Beck score and responder rates. Mirtazapine was well tolerated, while the trazodone-treated patients experienced somnolence more frequently, particularly during the first 2 weeks of treatment. Furthermore, postural symptoms were a clinical problem in 6% of the trazodone-treated patients. In this trial, mirtazapine showed significant clinical advantages over trazodone in terms of overall efficacy and tolerability.

Growth hormone response to clonidine in untreated depressed patients.

Growth hormone (GH) responses to i.v. clonidine administration (150 micrograms) were compared in untreated depressed patients and controls. There were 8 controls (6 males, 2 females), 16 patients with a major depressive episode (8 males, 8 females), and 16 matched patients with a minor depressive episode according to Research Diagnostic Criteria. Differences in the GH response to clonidine only occurred between male patients and controls. These results suggest that endocrinological variables are important in the interpretation of this neuroendocrine test. Findings in the subgroup of unmedicated male patients with a nonendogenous major depressive episode support the hypothesis of decreased noradrenergic receptor sensitivity.

Growth hormone response to clonidine in panic disorder patients.

The growth hormone (GH) response to clonidine administration (2 micrograms/kg) was compared in three groups of subjects: seven panic disorder patients, seven depressed patients matched for age and sex, and seven normal controls. As previously reported, patients with affective disorders show a blunted GH response to clonidine. Only one panic disorder patient had a blunted GH response to clonidine, and this patient had recently received a tricyclic antidepressant.

Latencies of REM sleep and awakening in major depression: possible indicators of cholinergic activity.

REM latency and awakening latency were analyzed in a sample of 26 major depressive inpatients and 8 male controls recorded for two consecutive nights. A significant inverse relationship appeared between REM latency and awakening latency in depressed patients. The relationship was more marked in male than in female patients. No significant correlation between REM latency and awakening latency was observed in male healthy volunteers. The hypothetical cholinergic supersensitivity in major depression is proposed to explain the present relationship. These results suggest that awakening latency might also be taken into account in the evaluation of sleep disturbances in depressive illness.

[Functional analysis of depressive states: integration of cognitive and behavioral contributions (author's transl)]. / Analyse fonctionnelle des états dépressifs: intégration des apports cognitifs et comportementaux.

The article provides a review of the main contributions both of behaviorally--and cognitively--oriented litterature on depressive states and depressive behaviors. These various data are organised so as to form into a tool for the functional analysis of depression: symptoms--structures--releasing factors--mechanisms--maintaining and aggravating factors. Synthetic tables at the end of the article constitute a first attempt at a clinical report allowing the pratician to evaluate the contributions--as well as the limits--of a behavioral approach of the depression phenomenom.

[French adaptation and validation of the Carroll rating scale for depression]. / Adaptation française et validation du "Carroll Rating Scale for depression".

The authors translated the Carroll Rating Scale for depression published in 1982. They evaluated the reliability of this scale in 50 normal volunteers. They validated the French Version against the Hamilton Rating Scale and the Beck Depression Inventory. The translation has been shown to be reliable. The correlation between the Hamilton Rating Scale and the Carroll Rating Scale is better than the one between the Hamilton Rating Scale and the Beck Depression Inventory. The Carroll Rating Scale appears to be useful for a quick evaluation of depressive symptoms.

[Pharmacological treatment of depression]. / Le traitement pharmacologique de la dépression.

Major depression is a frequent and incapacitating illness. Recent research has established its natural course, often characterised by chronicity or recurrent episodes, leading to long-term pharmacotherapy. Effective pharmacologic treatments are available for depression, including tricyclic antidepressants, monoamine oxidase-inhibiting agents, and newer medications. Successful pharmacotherapy for depression requires consideration of the profile of the antidepressant drugs, to balance their therapeutic effects and side effects profiles.

[Asthma: psychosomatic disease in children and adults (scientific and literary review of the literature)]. / L'asthme: maladie psychosomatique de l'enfant et de l'adulte (revue de littérature scientifique et littéraire).

The personality of the asthmatic child, and his relation with his mother-characterized by an absence of normal separation and individuation-is examined through scientific and literary sources. The familial milieu and various behavioral attitudes of the asthmatic patient are also considered. Various therapeutic approaches are discussed.