Classification of Depression and Response to Antidepressive Therapies

1983 ◽  
Vol 143 (6) ◽  
pp. 601-603 ◽  
Author(s):  
M. T. Abou-Saleh ◽  
A. Coppen
Keyword(s):  
Linear Relationship ◽  
Electroconvulsive Therapy ◽  
Antidepressant Medication ◽  
Unipolar Depression ◽  
Depressive Illness ◽  
Curvilinear Relationship ◽  
Middle Range ◽  
Percentage Improvement ◽  
One Year

SummaryTwo hundred inpatients suffering from primary depressive illness were studied. Seventy eight of the patients were treated by electroconvulsive therapy (ECT) and 122 patients received antidepressant medication. Response to ECT and antidepressant medication at 4 weeks showed a curvilinear relationship to Newcastle scores. Patients with Newcastle scores in the middle range (4–8) showed significantly higher percentage improvement than those with low (0–3) and high (9–12) scores. Ninety five patients with unipolar depression who received lithium therapy for one year were also studied. Response to lithium showed a linear relationship to Newcastle scores in these patients. It is suggested that these differences in response to antidepressant therapies reflect the heterogeneity of depressive illness.

Continuation Therapy with Amitriptyline in Depression

1978 ◽  
Vol 133 (1) ◽  
pp. 28-33 ◽  
Author(s):  
A. Coppen ◽  
K. Ghose ◽  
S. Montgomery ◽  
V. A. Rama Rao ◽  
J. Bailey ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Plasma Concentrations ◽  
Antidepressant Medication ◽  
Depressive Illness ◽  
Continuation Therapy ◽  
One Year ◽  
To Receive

SummaryThirty-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.

scholarly journals Use of Electroconvulsive Therapy in Adolescents: A Retrospective Study

2020 ◽  
pp. 025371762095673
Author(s):  
Sandeep Grover ◽  
Venkatesh Raju ◽  
Subho Chakrabarti ◽  
Akhilesh Sharma ◽  
Ruchita Shah ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scales ◽  
Psychotic Disorders ◽  
Retrospective Chart Review ◽  
Unipolar Depression ◽  
Percentage Improvement ◽  
Number Of Patients ◽  
Common Diagnosis ◽  
The Mean ◽  
Pressure Changes

Background: This study aimed to evaluate the clinical profile of adolescents aged up to 19 years who had received electroconvulsive therapy (ECT). Methods: A retrospective chart review was carried out to identify adolescents aged up to 19 years who had received ECT during the period 2012–2018. Details regarding their sociodemographic and clinical variables and ECT data were extracted from the records. Results: During the study period, a total of 51 adolescents received ECT, and complete records of 50 patients were available for analysis. 4.04% (51 out of 1260) of the patients who received ECT were aged up to 19 years. There was a decreasing trend of use of ECT over the years. The most common diagnosis was schizophrenia (42%), and this was followed by bipolar disorder (22%) and unipolar depression (20%). The mean number of ECTs administered per patient was 8.84 (SD: 5.34; range: 1–21). On the various rating scales, the percentage improvement in patients with psychotic disorders was 77.4%. For patients with depression, the percentage improvement was 77.2%, and that for mania was 80.3%. The percentage improvement in organic catatonia was 64.6%. The number of patients achieving ≥50% response ranged from 87.5% to 100%, and when the response was defined as ≥75% improvement, the proportion of patients varied from 50% to 76.9%. The majority of patients with depression (72.7%) and mania (77.8%) achieved remission. Immediate complications associated with the use of ECT included acute blood pressure changes (18%). Conclusion: ECT is effective and safe in adolescents with severe mental disorders. The clinician should not hesitate and delay the use of ECT in adolescents who require it.

Bipolar disorder

2017 ◽  
pp. 233-252 ◽  
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Unipolar Depression ◽  
Depressive Illness ◽  
Mood Stabilizers ◽  
Manic Depressive Illness ◽  
Bipolar Illness ◽  
Manic Depressive ◽  
Additional Section

‘Bipolar disorder’ provides an account of the clinical and scientific aspects of bipolar disorder (‘manic depressive illness’). Identification of varying degrees of mood elevation is critical to the diagnosis of bipolar disorder to allow its distinction from unipolar depression, and the phenomenology and classification of manic states is described in detail. The range of aetiological factors involved in the development of bipolar illness is covered, from genetics and brain structure to psychology and life events. The efficacy of treatments both psychological and pharmacological in bipolar disorder is assessed, including new approaches with psychoeducation, atypical antipsychotic drugs, and anticonvulsant mood stabilizers. An additional section covers the clinically challenging treatment of bipolar depression. The evidence from clinical trials is then placed in the context of good clinical management of both the acute phases of bipolar illness as well as longer-term maintenance treatment.

Issues in the Assessment of Post-ECT Memory Changes

1971 ◽  
Vol 119 (548) ◽  
pp. 73-74 ◽  
Author(s):  
Lily Brunschwig ◽  
James J. Strain ◽  
Thomas George Bidder
Keyword(s):  
Electroconvulsive Therapy ◽  
Depressive Illness ◽  
Therapeutic Result ◽  
Double Blind ◽  
Symptom Remission ◽  
One Year

In this study memory changes during and after electroconvulsive therapy were investigated by means of three different tests. The investigation was double-blind and the subjects were 96 patients hospitalized with depressive illness. Amounts of post-ECT amnesia were evaluated in relation to number of treatments for symptom remission and stability of the therapeutic result over the period of one year.

Lithium Continuation Therapy Following Electroconvulsive Therapy

1981 ◽  
Vol 139 (4) ◽  
pp. 284-287 ◽  
Author(s):  
A. Coppen ◽  
M. T. Abou-Saleh ◽  
P. Milln ◽  
J. Bailey ◽  
M. Metcalfe ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Depressive Illness ◽  
High Rate ◽  
Double Blind Trial ◽  
Double Blind ◽  
Blind Trial ◽  
Clinical Recovery ◽  
Continuation Therapy ◽  
One Year ◽  
To Receive

SummaryThirty-eight depressed patients who were treated with ECT were randomly assigned to receive lithium therapy or identical-looking placebo tablets for one year after clinical recovery in a double-blind trial. The patients who received placebo tablets spent an average of 7.8 weeks with an episode of depression (either as in-patients or day-patients) during the year. In comparison, patients who received lithium spent on average 1.7 weeks with an episode (P <0.02). The trial confirms the high rate of relapses after ECT and suggests that lithium considerably reduces this morbidity. It is suggested that ECT without continuation therapy is not a satisfactory treatment of depressive illness.

scholarly journals Antidepressant prescribing in general practice – how long can this go on?

1991 ◽  
Vol 15 (5) ◽  
pp. 281-283 ◽  
Author(s):  
Michael P. Kerr
Keyword(s):  
General Practice ◽  
Maintenance Treatment ◽  
Antidepressant Medication ◽  
Unipolar Depression ◽  
Acute Illness ◽  
Duration Of Treatment ◽  
One Year ◽  
Prevention Of Relapse ◽  
Term Maintenance

Present guidelines for the prescribing of antidepressant medication, with particular reference to the duration of treatment, are unclear (BNF, 1989). Evidence suggests that continuation of treatment for at least six months is valuable in the prevention of relapse of the acute illness (Mindham et al, 1975). Other workers have demonstrated a prophylactic effect similar to lithium over a three year period in patients with unipolar depression. There is, however, a paucity of information about the benefits (or lack of benefits) of longer term maintenance treatment. This study focuses on a population of a type which has been previously studied elsewhere – of patients in general practice receiving long-term (greater than one year) antidepressant medication. The implications of this to the psychiatrist and general practice–psychiatry liaison are discussed.

Relationship between pre-operative anxiety and post-operative state

1980 ◽  
Vol 10 (2) ◽  
pp. 361-367 ◽  
Author(s):  
Marie Johnston ◽  
Lucy Carpenter
Keyword(s):  
Negative Affect ◽  
Linear Relationship ◽  
Emotional State ◽  
Surgical Patients ◽  
Curvilinear Relationship ◽  
High Anxiety ◽  
Subsequent Research ◽  
Poor Outcome ◽  
Poor Predictor

SYNOPSISJanis (1958) has proposed a curvilinear relationship between pre-operative anxiety and post-operative emotional state. While other hypotheses share the prediction of a poor outcome for patients with pre-operative high anxiety, Janis' theory is unique in predicting a poor outcome for those with low anxiety. Subsequent research has failed to confirm Janis' hypotheses, perhaps because the designs have been insensitive to the predictions for low anxiety patients.The current study tests the hypothesis more directly and finds some support for a linear relationship between pre-operative anxiety and post-operative negative affect, with no support for Janis' curvilinear hypothesis. On the whole, pre-operative anxiety was a poor predictor of other measures of recovery but, on one measure, patients with low anxiety showed a slower recovery than those with moderate anxiety, i.e. supporting the prediction of a poor outcome for low anxiety patients.The implications of these results for pre-operative preparation of surgical patients and the development of theories of anxiety are discussed.

The twelve-month outcome of patients with neurotic illness in general practice

1981 ◽  
Vol 11 (3) ◽  
pp. 535-550 ◽  
Author(s):  
A. H. Mann ◽  
R. Jenkins ◽  
E. Belsey
Keyword(s):  
Social Life ◽  
Function Analysis ◽  
Psychiatric Morbidity ◽  
The Social ◽  
Assessment Measures ◽  
Psychiatric State ◽  
One Year

SYNOPSISOne hundred patients, selected to be representative of those attending general practitioners with non-psychotic psychiatric disorders were followed up for one year. standard assessments of mental state, personality, social stresses and supports were carried out for each patient at the outset and after a year.The outcome for this cohort determined both by the level of psychiatric morbidity at interview after one year and by the pattern of the psychiatric morbidity during the year has been analysed with reference to the assessment measures. Discriminant function analysis indicates that the initial estimate of the severity of the psychiatric morbidity and a rating of the quality of the social life at the time of follow-up are the only factors that significantly predict the psychiatric state after one year. Social measures also predict a pattern of illness charactorized by a rapid recovery after the initial assessemtn. Patients who reported continuous psychiatric morbidity during the year were, older, physically ill and very likely to have recevied psychotropic drugs. Receipt of this medication during the year was associated with initial assessments of abnormality of personality, older age, and a diagnosis of depression.The findings of this study are seen to support a triaxial assessment and classification of non-psychotic psychiatirc disorders, with symptoms, personality and social state being rated independently.

When should ECT be used?

1977 ◽  
Vol 15 (1) ◽  
pp. 2-4
Keyword(s):  
Electroconvulsive Therapy ◽  
Mode Of Action ◽  
Depressive Illness ◽  
Muscle Relaxants ◽  
House Of Commons ◽  
Mode Of Administration ◽  
Lay People ◽  
Harmful Effects

Though electroconvulsive therapy (ECT) has been widely used in depressive illness for over 30 years, its use is empirical, its mode of action remains unknown, and some medical and lay people have asserted that its dangers outweigh its usefulness. Over the years the mode of administration has gradually changed with the introduction of anaesthetics and muscle relaxants. The number of shocks in a course of ECT has tended to lessen and unilateral ECT has some advantages.1 Nevertheless, recently the long-standing controversy on its use has increased. In some states in America legislation has been introduced to restrict it2 and questions on its possible harmful effects have been asked in the House of Commons.3

scholarly journals Development of new antidepressants

1997 ◽  
Vol 3 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Eleni Palazidou
Keyword(s):  
Monoamine Oxidase ◽  
Turning Point ◽  
Monoamine Oxidase Inhibitor ◽  
Depressive Illness ◽  
Oxidase Inhibitor ◽  
Tricyclic Antidepressant ◽  
Antituberculous Drugs ◽  
One Year

The development of the first effective antidepressants in the late 1950s marked a turning point in the treatment of depressive illness. In 1957 the monoamine oxidase inhibitor (MAOI) iproniazid was discovered by chance, while searching for new antituberculous drugs. One year later the tricyclic antidepressant (TCA) imipramine was introduced, having been developed originally as an antipsychotic. A number of other drugs were subsequently added to these two groups of antidepressants, which dominated the field for the next three decades.

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