Lithium Augmentation Therapy in Tricyclic-Resistant Depression

1993 ◽  
Vol 162 (5) ◽  
pp. 634-640 ◽  
Author(s):  
George Stein ◽  
Morris Bernadt
Keyword(s):  
Low Dose ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Antidepressant Effect ◽  
Significant Difference ◽  
Resistant Depression ◽  
Drug Responsiveness ◽  
Experimental Group ◽  
Lithium Augmentation

Thirty-four patients with tricyclic-resistant depressive illness took part in a nine-week, doubleblind, placebo-controlled trial of lithium augmentation. In addition to the maximum tolerated doses of their tricyclic antidepressant, the experimental group (n= 16) received 250 mg lithium daily for three weeks, followed by 750 mg lithium daily for six weeks, while the controls (n= 18) received placebo for three weeks followed by three weeks each of 250 mg lithium daily and 750 mg lithium daily. There was no significant difference between placebo and 250 mg lithium for weeks 0-3 of the trial. However, there was a significantly greater improvement on the MADRS for weeks 3-6 for those subjects on 750 mg lithium than for those on 250 mg lithium. In addition, using a 50% fall in the HRSD as a criterion of drug responsiveness, 22% responded to placebo, 18% to 250 mg lithium, and 44% to 750mg lithium. Thus, lithium in normal, but not in low, dose has a significant antidepressant effect in TCA-resistant depression. Further controlled studies using lithium in normal dose in trials which have a greater duration of placebo exposure are required to confirm the lithium augmentation effect.

Placebo-Controlled Trial of Lithium Augmentation of Fluoxetine and Lofepramine

1995 ◽  
Vol 166 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Cornelius L. E. Katona ◽  
Mohammed T. Abou-Saleh ◽  
Deborah A. Harrison ◽  
Bertrand A. Nairac ◽  
Denzil R. L. Edwards ◽  
...  
Keyword(s):  
Rating Scale ◽  
Antidepressant Treatment ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Controlled Trials ◽  
Major Depressive ◽  
Double Blind ◽  
Primary Care Settings ◽  
Resistant Depression ◽  
Lithium Augmentation

BackgroundThis study was designed to establish whether (as suggested in a number of open and relatively small controlled trials) lithium augmentation is more effective than continued antidepressant alone, where response to a standard course of antidepressant treatment has been absent or partial.MethodLithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness (in both hospital and primary care settings) who had failed to respond to a controlled trial of fluoxetine or lofepramine. Response was defined as a final Hamilton Depression Rating Scale (HDRS) score of < 10.ResultsResponse was seen more frequently in patients taking lithium (15/29) than in those remaining on antidepressant alone (8/32; P < 0.05). Rapid response to lithium augmentation (LA) was not consistently observed in this cohort. Mean HDRS scores after six weeks were significantly lower (P < 0.01) in the lithium group after excluding those who had not achieved significant exposure to lithium (arbitrarily defined as two or more lithium levels ≥ 0.4 mmol/1). No differences in the efficacy of LA were apparent between fluoxetine and lofepramine.ConclusionsOur results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression. Partial response was, however, frequently observed with continued antidepressant treatment alone, and the superiority of LA appears to depend on achieving adequate serum lithium levels.

Does soft tissue mobilization assist static stretching to improve hamstring flexibility? A randomized controlled trial

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Shibili Nuhmani
Keyword(s):  
Soft Tissue ◽  
Controlled Trial ◽  
Knee Extension ◽  
Repeated Measure ◽  
Control Group ◽  
Static Stretching ◽  
Significant Difference ◽  
Hamstring Flexibility ◽  
Soft Tissue Mobilization ◽  
Experimental Group

AbstractObjectivesObjective of the study is to investigate whether Soft tissue mobilization (STM) can assist with static stretching to improve hamstring flexibly.MethodsThe design of the study was repeated measure design. The study was conducted at the physical therapy laboratory of Jamia Hamdard University, New Delhi. Participants included 78 healthy males with hamstring tightness, randomly assigned to either the control group (static stretching) or the experimental group (STM and static stretching). The experimental group received five sets of four different STM techniques, followed by two sets of 30-s static stretches 3 days per week over the course of 12 weeks. The control group received 5 min of sham ultrasound with an inactive probe prior to static stretching. Active knee extension test (AKE) was the outcome measure.ResultsBoth groups showed significant improvement in AKE compared with the baseline measurements. With ingroup analysis showed a significant difference in AKE across all measured time periods (weeks 4, 8, and 12) with pre-test in both groups (p<0.05). No significant difference in AKE improvement was found between groups (p>0.05).ConclusionThe results of this study show that STM prior to static stretching does not significantly improve hamstring flexibility among healthy individuals. Although this study cannot be generalized, the results may be useful for evidence-based practice in the management of hamstring tightness.

Lithium in Tricyclic-Resistant Depression Correlation of Increased Brain 5-HT Function with Clinical Outcome

1991 ◽  
Vol 159 (3) ◽  
pp. 341-346 ◽  
Author(s):  
P. J. Cowen ◽  
S. L. McCance ◽  
C. J. Ware ◽  
P. R. Cohen ◽  
J. S. Chalmers ◽  
...  
Keyword(s):  
Lithium Treatment ◽  
Antidepressant Medication ◽  
Tricyclic Antidepressant ◽  
Antidepressant Effect ◽  
Endocrine Response ◽  
Treatment Combination ◽  
Prolactin Release ◽  
Limited Support ◽  
Resistant Depression ◽  
Prolactin Response

The addition of lithium to the tricyclic antidepressant medication of 23 patients with major depression resulted in an increase in the prolactin response to intravenous l-tryptophan after both four days and four weeks of treatment. The extent of this increase did not distinguish the ten patients who were classified as clinical responders (> 50% reduction in score on the HRSD). Among the responders there was a modestly significant correlation between the decrease in score on the HRSD and the enhancement of tryptophan-induced prolactin release. Some responders, however, showed very little change in this endocrine response over the four weeks of lithium treatment. Lithium may increase brain 5-HT function in tricyclic-resistant depression but there is only limited support for the hypothesis that changes in brain 5-HT function are involved in the antidepressant effect of this treatment combination.

scholarly journals Effectiveness Of Topical Application Of Chlorhexidine And Prevailing Practices On Episiotomy Wound Among Postnatal Mothers

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Rincy Michael ◽  
Soney N Toppo ◽  
Varsha Hariharan
Keyword(s):  
Wound Healing ◽  
Topical Application ◽  
Controlled Trial ◽  
Demographic Data ◽  
Assessment Scale ◽  
Research Centre ◽  
Control Group ◽  
Significant Difference ◽  
Postnatal Mothers ◽  
Experimental Group

Puerperium is a period when the mother experiences intense physical and emotional stress due to exhaustion, anxiety and excitement. Each mother has to adjust to physical changes in her own body due to involution and lactation as well as cope up with the new demands on her time and emotions made by the new born baby. Episiotomy, despite evidences that it is an unnecessary intervention, is one of the most common surgical procedures performed during the second stage of labour, especially in primigravida woman. Thus, a randomized controlled trial to assess the effectiveness of topical application of chlorhexidine and prevailing practices on episiotomy wound among postnatal mothers at selected hospital of Indore was undertaken. True experimental approach with pre test post test research design was adopted. Simple random sampling was taken to select 40 postnatal mothers with episiotomy wound and three days postpartum hospital stay in Choithram Hospital & Research Centre, Indore as per the inclusion criteria. Data was collected with help of questionnaire for socio demographic data and obstetrical data and the wound healing was assessed by REEDA wound healing assessment scale. Samples in the experimental group were applied with chlorhexidine on episiotomy wound and the samples in the control group received routine care with betadine or nadoxin. Post assessment score was taken on third day (evening) by REEDA wound assessment scale. Finding of the study related to effectiveness of chlorhexidine among postnatal mothers in experimental group revealed that there was a significant difference in the healing of episiotomy wound by the application of chlorhexidine among postnatal mothers in experimental group at t19 = 11.40 at the level of p< 0.001. Hence it was inferred that topical application of chlorhexidine on episiotomy wound promotes wound healing.

scholarly journals Effect of low-dose lidocaine on objective upper extremity strength and immediate pain relief following cervical interlaminar epidural injections: a double-blinded randomized controlled trial

2020 ◽  
Vol 45 (10) ◽  
pp. 767-773
Author(s):  
Zachary L. McCormick ◽  
Taylor Burnham ◽  
Shellie Cunningham ◽  
Richard W Kendall ◽  
David Bougie ◽  
...  
Keyword(s):  
Pain Relief ◽  
Upper Extremity ◽  
Low Dose ◽  
Controlled Trial ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Spinal Block ◽  
Epidural Injections ◽  
Significant Difference ◽  
Double Blinded

BackgroundLow-dose lidocaine is a common diluent for analgesia following cervical interlaminar epidural steroid injection (CIESI). Concerns with this practice exist. A single-arm cohort reported that 20% of patients develop postprocedural upper extremity weakness when using lidocaine as a diluent. Furthermore, a high-cervical spinal block with unintended intrathecal or subdural administration is possible.ObjectiveDetermine if low-dose lidocaine as a diluent during CIESI causes clinically meaningful (1) upper extremity weakness and (2) immediate pain relief when compared with saline.DesignDouble-blinded randomized control trial.MethodsPatients with cervical radicular pain scheduled for CIESI were enrolled. Participants received lidocaine (CIESI-L) or saline (CIESI-S) as a diluent for the epidural injectate. Myotomal strength was measured with dynamometry before and between 20 and 30 min after CIESI. Pre-pain and post-pain scores were obtained. Primary and secondary outcomes were post-CIESI weakness of ≥20% (minimal clinically important difference (MCID)) in >1 myotome and ≥50% pain reduction on the numerical scale.Results120 participants (64 females (53%), mean age, 56 (SD 13.7) years) completed the study and were analyzed (CIESI-L n=60; CIESI-S n=60). There was no significant between-group difference in the proportion of participants with postprocedural weakness, CIESI-L 41.7% (95% CI, 29.8% to 54.5%), CIESL-S 50% (95% CI, 37.5% to 62.5%). Between-group comparison showed no significant difference in pain reduction, relative risk 1.53 (95% CI, 0.82 to 2.86).ConclusionLow-dose lidocaine as a diluent in CIESI does not significantly increase the risk of post-CIESI myotomal weakness when compared with saline, but also does not substantially increase the likelihood of immediate, meaningful pain relief.Trial registration detailsClinicalTrials.gov (NCT03127137); December 26, 2017.

High-Dose Nadroparin Following Endovascular Aneurysm Treatment Benefits Outcome After Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 281-287 ◽  
Author(s):  
Rene Post ◽  
IJsbrand A.J Zijlstra ◽  
Rene van den Berg ◽  
Bert A Coert ◽  
Dagmar Verbaan ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Dose Group ◽  
Low Dose ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Controlled Trial ◽  
Delayed Cerebral Ischemia ◽  
Neurological Status ◽  
High Dose ◽  
Aneurysm Treatment ◽  
Significant Difference

Abstract BACKGROUND Delayed cerebral ischemia (DCI) is one of the major causes of delayed morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To evaluate the effect of high-dose nadroparin treatment following endovascular aneurysm treatment on the occurrence of DCI and clinical outcome. METHODS Medical records of 158 adult patients with an aSAH were retrospectively analyzed. Those patients treated endovascularly for their ruptured aneurysm were included in this study. They received either high-dose (twice daily 5700 AxaIE) or low-dose (once daily 2850 AxaIE) nadroparin treatment after occlusion of the aneurysm. Medical charts were reviewed and imaging was scored by 2 independent neuroradiologists. Data with respect to in-hospital complications, peri-procedural complications, discharge location, and mortality were collected. RESULTS Ninety-three patients had received high-dose nadroparin, and 65 patients prophylactic low-dose nadroparin. There was no significant difference in clinical DCI occurrence between patients treated with high-dose (34%) and low-dose (31%) nadroparin. More patients were discharged to home in patients who received high-dose nadroparin (40%) compared to low-dose (17%; odds ratio [OR] 3.13, 95% confidence interval [95% CI]: 1.36-7.24). Furthermore, mortality was lower in the high-dose group (5%) compared to the low-dose group (23%; OR 0.19, 95% CI: 0.07-0.55), also after adjusting for neurological status on admission (OR 0.21, 95% CI: 0.07-0.63). CONCLUSION Patients who were treated with high-dose nadroparin after endovascular treatment for aneurysmal SAH were more often discharged to home and showed lower mortality. High-dose nadroparin did not, however, show a decrease in the occurrence of clinical DCI after aSAH. A randomized controlled trial seems warranted.

Educational Video Intervention Effects on Periprocedural Anxiety Levels Among Cardiac Catheterization Patients: A Randomized Clinical Trial

2016 ◽  
Vol 30 (1) ◽  
pp. 70-84 ◽  
Author(s):  
Shahnaz Mohammed Ayasrah ◽  
Muayyad M. Ahmad
Keyword(s):  
Cardiac Catheterization ◽  
Controlled Trial ◽  
Test Procedure ◽  
Group Versus ◽  
Educational Video ◽  
Video Intervention ◽  
Significant Difference ◽  
Anxiety Levels ◽  
Experimental Group ◽  
Video Education

Purpose: To explore the effectiveness of an educational video intervention in lowering periprocedural anxiety among Jordanian patients hospitalized for cardiac catheterization (CATH). There are many potential reasons of anxiety related to CATH including involvement of the heart and the actual test procedure. Methods: A randomized controlled trial took place in a specialized heart institute in Jordan. The sample size was 186 patients who had undergone CATH procedure. Patients anxiety levels were measured by physiological parameters of anxiety (blood pressure, heart rate, and respiratory rate) and by the Spielberger State Anxiety Inventory (SAI). Results: After video education, there was a significant difference in periprocedural perceived anxiety between the groups: preprocedural anxiety levels (M = 39.03, SD = 5.70) for the experimental group versus (M = 49.34, SD = 6.00) for the control, p < .001, and postprocedural perceived anxiety for the experimental group (M = 29.18, SD = 5.42) versus (M = 41.73, SD = 5.41) for the control. Conclusion: Providing an educational video intervention about CATH may effectively decrease periprocedural anxiety levels.

A Placebo Controlled Trial of Viloxazine with and without Tranquillizers in Depressive Illness

1975 ◽  
Vol 3 (3) ◽  
pp. 207-213 ◽  
Author(s):  
R V Magnus
Keyword(s):  
Side Effects ◽  
Clinical Effect ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Antidepressant Effect ◽  
Double Blind ◽  
Depressed Patients ◽  
Crossover Studies

Two double-blind four-way crossover studies are reported, comparing the antidepressant effect of 14-day courses of: viloxazine, viloxazine with a tranquillizer either perphenazine or diazepam or tranquillizer alone, against a placebo. In one study the antidepressant effect of viloxazine at a dose of 150 mg daily was statistically greater than that of placebo, whilst in the second study viloxazine was statistically superior to diazepam (15 mg daily). In depressed patients with a clear anxiety component, viloxazine alone seemed preferable to a combination with a tranquillizer as such a combination did not produce an enhanced clinical effect and the incidence of side-effects was possibly increased. Viloxazine was generally well tolerated and side-effects, when they occurred, were generally a mild upper gastro-intestinal disturbance.

scholarly journals Modulation of the human immune status by spinal thermal massage: a non-randomized controlled study

2021 ◽  
Keyword(s):  
Quality Of Life ◽  
Nk Cells ◽  
Nk Cell ◽  
Controlled Trial ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Experimental Group

Thermal and massage therapies have long been used to control pain. Although spinal thermal massage (STM) has been used worldwide, its effectiveness has not been proven in a controlled clinical study. We here conducted a non-randomized controlled trial to assess the pain-relieving and immunomodulatory effects of STM in old-aged patients experiencing pain or disability. The experimental group was treated with STM five times a week for 8 weeks and rehabilitative regular care (RRC). The control group was treated with only RRC. Pain and immunological parameters were tested before treatment and after 4 and 8 weeks of treatment. The scores of three pain parameters were lowered by STM, and the differences between the groups were statistically significant at the two time points (p < 0.01). Quality of life determined using the 3-level EuroQol five-dimensional questionnaire scores was significantly higher in patients in the experimental group than those in the control group. Effect sizes (ES) were in the range of medium to large in the pain-related measures (0.54–1.22). The total leukocyte counts and the proportions of lymphocytes and subsets were not significantly different between the groups, whereas the proportions of monocytes and natural killer (NK) cells were higher in the experimental group than in the control group after 8 weeks (p < 0.05). The production of interleukin (IL)-4 and interferon γ in T cells was not significantly different between the groups, whereas the production of IL-2 was high in the control group. However, there was a significant increase in IFN-γ production by NK cells in the experimental group (at 4 weeks, p < 0.05). ES were medium in the immunological measures (0.53–0.68). No significant difference was observed in the production of proinflammatory cytokines, IL-1β, tumor necrosis factor α, or IL-6 between the groups. In conclusion, STM treatment has a positive effect on subjective pain and quality of life. It also enhanced NK cell proportion and activity, suggesting that STM may be beneficial in the prevention of viral diseases and cancer in old-aged people.

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