Rapid antidepressant response after nocturnal TRH administration in patients with bipolar type I and bipolar type II major depression.

BACKGROUND: Thyrotropin-releasing hormone (TRH) is a tripeptide that produces endocrine and behavioral effects in animals and humans. Some studies have shown transient antidepressant activity after morning administration of TRH. We hypothesized that nocturnal administration of TRH, when the circadian sensitivity of the TRH receptor is at its peak, may result in a more robust antidepressant effect. METHODS: Twenty patients with bipolar (BP) type I or BP type II major depressive episode (MDE) were given nocturnal intravenous TRH 500 microg (n = 10) or saline (n = 10) at midnight in a randomized, double-blind fashion. Antidepressant activity was assessed using the Hamilton Depression Rating (HAM-D), Young Mania Rating (YMR), and Profile of Mood (POMS) scales over a 48-hour period. Thyrotropin (TSH), total T4, and free T3 concentrations were measured before and after TRH administration. Data were analyzed using chi test, Fisher exact test, and repeated-measures ANOVA. RESULTS: Sixty percent of the TRH group and 10% of the saline group showed a > or =50% reduction in baseline total HAM-D score within 24 hours (P = 0.03). HAM-D ratings fell by an average of 52% after TRH administration versus 12% after saline administration (P = 0.038). There was a modest increase in YMR scores after TRH compared with saline (P < 0.032). No manic or hypomanic episodes were observed. Antidepressant effects of TRH lasted up to 48 hours. There was no correlation between DeltaTSH, DeltaT4, or DeltaT3 measures after TRH (or saline) administration and the change in HAM-D scores. CONCLUSIONS: Nocturnal TRH administration may produce a rapid antidepressant effect in some patients with BP I and BP II MDE.

Psychiatry Resident and Medical Student Perspectives on ECT: Influence of Exposure and Education.

We surveyed medical students doing the required psychiatry clerkship at our hospital and first-year psychiatry residents in our residency training program for their attitudes, knowledge, and opinions about electroconvulsive therapy (ECT) before and after their inpatient rotations. The students' knowledge was lower and their attitudes more negative toward ECT than those of residents at baseline. Upon completion of the rotation, students and residents had more knowledge and highly positive attitudes about ECT and stated that they would undergo ECT if it were recommended. Willingness to undergo ECT if it were recommended correlated with the knowledge measures of ECT.

Electroconvulsive Therapy and Brain Glucose Metabolism.

The local cerebral metabolic rate for glucose (LCMRGlc) was evaluated in four patients before undergoing a course of electroconvulsive therapy (ECT) and after its completion. There was no reduction in LCMRGlc when studied 1 day after the last course of ECT. There was, however, the suggestion that metablic rates may increase in the middle frontal gyrus after significant time has elapsed since the last course of ECT.

Patient and Family Perspectives of Electroconvulsive Therapy: Correlation with Outcome.

We surveyed 25 patients about to undergo electroconvulsive therapy (ECT) and one relative of each patient for their attitudes, knowledge, and opinions about ECT; and then resurveyed them after the course of ECT. Patients were rated with the Hamilton Depression Rating Scale or Young Mania Rating Scale, based on diagnosis, before and after ECT. Patients and family members had highly positive attitudes toward ECT both before and after treatment, and after the course felt strongly that the ECT was beneficial. Baseline depression severity gave a high correlation with positive post-ECT attitudes.