RESUMEN
Assessment of metabolic rate was useful in evaluating refractory depression in six of 15 women. Five of the six had normal levels of T3 and T4; however, each had an elevated thyrotropin-stimulating hormone level or a low metabolic rate. The depressions responded to medication with thyroid hormone.
Asunto(s)
Trastorno Depresivo/fisiopatología , Glándula Tiroides/fisiopatología , Adulto , Metabolismo Basal , Trastorno Depresivo/complicaciones , Trastorno Depresivo/tratamiento farmacológico , Femenino , Humanos , Hipotiroidismo/complicaciones , Persona de Mediana Edad , Tirotropina/sangre , Tiroxina/sangre , Tiroxina/uso terapéutico , Triyodotironina/sangreRESUMEN
Some depressed patients may suffer from restricted central hypothyroidism, which could occur if levels of the thyroid hormone transport protein transthyretin were low. CSF transthyretin was measured in eight inpatients with refractory major depression and nine neurological patients. The depressed patients had significantly lower transthyretin levels than the comparison subjects, suggesting that central hypothyroidism, with normal peripheral thyroid concentrations, could occur in some depressed patients.
Asunto(s)
Trastorno Depresivo/líquido cefalorraquídeo , Prealbúmina/líquido cefalorraquídeo , Adulto , Trastorno Depresivo/etiología , Femenino , Hospitalización , Humanos , Hipotiroidismo/complicaciones , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/líquido cefalorraquídeo , Proyectos PilotoRESUMEN
Four men with paruresis received trials of atenolol or phenelzine or both. Atenolol was effective in one patient. Three patients had a poor response to phenelzine, and they all experienced troublesome side effects.
Asunto(s)
Atenolol/uso terapéutico , Fenelzina/uso terapéutico , Trastornos Fóbicos/tratamiento farmacológico , Trastornos Urinarios/tratamiento farmacológico , Adulto , Atenolol/efectos adversos , Ensayos Clínicos como Asunto , Método Doble Ciego , Humanos , Masculino , Fenelzina/efectos adversos , Trastornos Fóbicos/complicaciones , Placebos , Trastornos Urinarios/etiología , Trastornos Urinarios/psicologíaRESUMEN
OBJECTIVE: Transthyretin plays an important role in the transport and distribution of thyroid hormone in the central nervous system (CNS). This study replicated and extended to patients with nonrefractory depressive illness a pilot study indicating that patients with refractory major depression have significantly lower levels of CSF transthyretin than do healthy comparison subjects. METHOD: Lumbar punctures were performed in drug-free subjects with DSM-III-R major depression (N = 18), DSM-III-R bipolar disorder, depressed phase (N = 1), and healthy comparison subjects (N = 24). CSF concentrations of transthyretin, determined by a quantitative dot-immunobinding assay, of the depressed patients and comparison subjects were compared by analysis of covariance (ANCOVA). The relationship between CSF transthyretin levels and Hamilton Depression Rating Scale scores was determined in a subset of the depressed patients. RESULTS: CSF concentrations of transthyretin were significantly lower in the depressed patients than in the comparison subjects by ANCOVA. Within the depressed group there was no significant overall correlation between CSF transthyretin levels and Hamilton depression scale scores, but there was a significant inverse correlation in male depressed patients (N = 8) between CSF transthyretin concentrations and Hamilton depression scores. CONCLUSIONS: Lower CSF transthyretin concentrations in depressed patients may reflect either a stable trait in this population or a state change secondary to depression or other factors. Lower CSF transthyretin concentrations may result in altered CNS thyroid hormone homeostasis. Such alteration could account for certain mood and neurovegetative symptoms of depression and might contribute to failure of standard antidepressant treatment.
Asunto(s)
Trastorno Depresivo/líquido cefalorraquídeo , Prealbúmina/líquido cefalorraquídeo , Adulto , Análisis de Varianza , Trastorno Bipolar/líquido cefalorraquídeo , Trastorno Bipolar/diagnóstico , Barrera Hematoencefálica , Sistema Nervioso Central/metabolismo , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/metabolismo , Femenino , Humanos , Hipotiroidismo/líquido cefalorraquídeo , Masculino , Proyectos Piloto , Prealbúmina/biosíntesis , Prealbúmina/metabolismo , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Tiroxina/metabolismoRESUMEN
Moral or religious scrupulosity is a disabling condition which is sometimes seen in patients with obsessive compulsive disorder (OCD). The authors described 10 patients with moral or religious scrupulosity who were treated with fluoxetine or clomipramine. Seven of the 10 patients completed open treatment of at least 8 weeks without requiring adjunctive medication; 5 of those 7 patients were rated as much improved. Among the 3 patients who required adjunctive medication, 1 was rated as much improved. Of the 4 nonresponders at 3 months, 2 responded after longer treatment trials. These results suggest that extreme moral or religious concerns and behaviors might be a form of OCD and that the scrupulosity can be effectively treated with serotonin reuptake blockers.
Asunto(s)
Clomipramina/uso terapéutico , Fluoxetina/uso terapéutico , Principios Morales , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Religión y Psicología , Adolescente , Adulto , Anciano , Catolicismo , Quimioterapia Combinada , Femenino , Humanos , Judaísmo , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/psicología , Evaluación de Procesos y Resultados en Atención de Salud , Escalas de Valoración PsiquiátricaRESUMEN
To determine the clinical significance of thyroid function abnormalities in patients maintained on lithium, the authors evaluated the relationships of thyroid function tests to clinical response to lithium and side effects from lithium in 20 outpatients meeting DSM-III criteria for major affective disorder. No significant relationships were found between baseline thyroid function tests and clinical response. Thyroxine (T4) and triiodothyronine uptake ratio (T3UR) within the normal range were found to be associated with complaints of lethargy and cognitive impairment. Thirteen subjects were followed prospectively for 6 months with monthly evaluations of affective state, side effects, and occurrence of relapse. Thyroid function tests were repeated at the final visit. Final and mean T3 levels within the normal range were found to be significantly lower in patients who relapsed, and mean T3 level was inversely correlated with affective state as measured by mean scores on the Hamilton Rating Scale for Depression and the Young Mania Rating Scale.