Frederick M. Jacobsen

Comparative anxiogenic, neuroendocrine, and other physiologic effects of m-chlorophenylpiperazine given intravenously or orally to healthy volunteers

The serotonin agonist m-chlorophenylpiperazine (m-CPP) had greater anxiogenic and other mood and cognitive effects when administered intravenously (0.1 mg/kg) rather than orally (0.5 mg/kg) to healthy subjects. Nonetheless, similar elevations in peak plasma cortisol and prolactin concentrations were obtained with the two dosage regimens, and temperature elevations were greater after oral m-CPP. Plateau phase plasma concentrations of m-CPP at the times of the maximum neuroendocrine responses to intravenous and oral m-CPP were similar. Since all rodent and nonhuman primate studies have used parenterally administered m-CPP, and previous clinical investigations using intravenous rather than oral m-CPP have yielded somewhat discrepant results, our normative data should be useful for comparing results, our normative data should be useful for comparing results across different human studies and across species.

Psychobiological effects of carbohydrate- and protein-rich meals in patients with seasonal affective disorder and normal controls

Patients with seasonal affective disorder (SAD) frequently report carbohydrate craving and note that carbohydrate ingestion energizes them. Bright artificial light has been shown to reverse the symptoms of SAD, including carbohydrate craving. In this study, 16 depressed SAD patients and 16 matched controls were fed two different isocaloric meals, one rich in protein and one rich in carbohydrates, in a crossover design. Although their biochemical response in terms of plasma large neutral amino acid concentrations was identical, SAD patients reported activation following carbohydrate ingestion, whereas normal controls reported sedation. Marked ordering effects on psychological parameters were noted, suggesting that order should be taken into account as a methodological consideration in meal studies.

Phototherapy for Seasonal Affective Disorder

is not a new one. Indeed, books were written on the subject in the early decades of this century (Humphris, 1924; Kovacs, 1932). However, there are important distinctions between the treatments outlined in these earlier texts and the phototherapy currently in use. These earlier clinicians regarded phototherapy as a broad-spectrum treatment for a wide variety of ills. Ultraviolet light was considered an important component of the treatments, and the entire body was exposed to the light. The emphasis was thus on exposing the skin to light, and special &dquo;light baths&dquo; were designed to maximize skin exposure and to shield the eyes from toxic ultraviolet rays. In contrast, phototherapy is currently regarded as helpful only with certain specific types of patients; the light sources used have contained relatively little ultraviolet light; and emphasis has been placed on the eyes rather than the skin as the portal of entry of the therapeutic effect. The majority of phototherapy studies conducted in the past few years have involved patients with SAD, a condition characterized by regular winter depressions alternating with nondepressed periods in the spring and summer (Rosenthal et al., 1984). There are a few recorded historical examples of manipulations of lighting and climate specifically aimed at reversing certain winter difficulties such as depression and lethargy. Esquirol (1845) reported a case of a man with symptoms remarkably similar to those of SAD, whom he treated successfully by advising him to move from

Neurobiology of Seasonal Affective Disorder and Phototherapy

I. To whom all correspondence should be addressed, at the Clinical Psychobiology Branch, NIMH. Building 1.0/Room 4S-239, 9000 Rockville Pike, Bethesda. Maryland 20892. The investigation of the biochemical basis of seasonal affective disorder (SAD) and light therapy is a new field. As with any body of knowledge undergoing rapid expansion, the data, though interesting, are incomplete and at times even conflicting. In this paper, we attempt to organize and synthesize the information currently available into a coherent and understandable form.

Sleep in fall/winter seasonal affective disorder: effects of light and changing seasons.

Disturbances of sleep are a hallmark of seasonal affective disorders (SAD), as they are of other mood disorders. Fall/winter SAD patients most often report hypersomnia. Among responses of 293 SAD patients on a symptom questionnaire, complaints of winter hypersomnia (80%) greatly exceeded insomnia (10%), hypersomnia plus insomnia (5%), or no sleep difficulty (5%). Increased sleep length in fall/winter is not unique to SAD. Among 1571 individuals across four latitudes surveyed at random from the general population, winter sleep increases of < or = 2 hr/day relative to summer were reported by nearly half. However, hypersomnia had a low correlation (r = 0.29) with the total number of other SAD symptoms that were reported in this sample. Ten SAD patients kept daily sleep logs across 1 yr that showed increases in fall and winter (sleeping most in October; least in May) whose maximum averaged 2.7 hr per day more weekend sleep than in spring and summer. These winter increases might have been somewhat attenuated since most received light therapy during part of the winter. Nocturnal EEG recordings of depressed SAD patients in winter showed decreased sleep efficiency, decreased delta sleep percentage, and increased REM density (but normal REM latency) in comparison with recordings: (1) from themselves in summer; (2) from themselves after > or = 9 days of light therapy; or (3) from age- and gender-matched healthy controls. Thus, the extent of fall/winter oversleeping recorded by our SAD patients did not differ dramatically from that reported by the general population, but sleep complaints of our SAD patients have been accompanied by features of sleep architecture that are different from healthy controls and are reversed by summer or by bright-light therapy.

Hormonal responses to the administration of m-chlorophenylpiperazine in patients with seasonal affective disorder and controls

We report on the plasma cortisol and prolactin responses to the serotonergic agonist m-CPP (0.1 mg/kg) in 10 patients with winter seasonal affective disorder (SAD) and 10 controls during the winter, in both untreated and bright light-treated conditions; and on 8 other SAD patients and 8 other controls during the summer. Following m-CPP infusion, untreated patients had exaggerated prolactin (p < .05) and cortisol (p < .05) responses compared to controls. Light treatment significantly reduced responses of both hormones to m-CPP (prolactin: p < .01; cortisol: p < .01). When untreated winter subjects and summer subjects were compared, cortisol, but not prolactin responses to m-CPP were found to be higher in patients than in controls during the winter, and lower in patients than in controls during the summer (diagnosis by season: p < .05). These results are consistent with those of our previous report on the behavioral responses to m-CPP in the same patients and suggest an abnormality in serotonergic function in untreated SAD patients in winter, which is normalized following treatment with light therapy and naturally during the summer.

Evidence for a decline with age in behavioral responsivity to the serotonin agonist, m-chlorophenylpiperazine, in healthy human subjects

The functional significance of alterations in brain serotonin (5HT) associated with normal aging in both animals and humans is largely unknown. Using the effects of the 5HT agonist, m-chlorophenylpiperazine (m-CPP), as a measure of central serotonergic responsivity, we compared the behavioral and neuroendocrine responses of older normal volunteers (mean age +/- SD = 62.4 +/- 4.12) to those of younger normal volunteers (mean age +/- SD = 31.6 +/- 5.52). When m-CPP was administered intravenously, older subjects showed decreased behavioral responses but similar neuroendocrine responses, compared to younger subjects. The decreased behavioral responsivity was unrelated to pharmaco-kinetic differences between the groups, since m-CPP plasma levels were similar in both groups. This report is the first in vivo study in humans to demonstrate decreased behavioral responsivity with age following serotonergic stimulation, and may indicate a functionally less responsive 5HT subsystem in older subjects.

Ethnocultural identification in psychotherapy.

Ethnoculturally translocated individuals, members of minority groups, and patients in cross-cultural psychotherapy frequently experience disturbances of their ethnocultural identities. During psychotherapy these patients often attribute ethnocultural qualities to their therapists in a process called ethnocultural identification. This process may be used to foster a therapeutic identification in which the therapist reflects pieces of the patients conflicted ethnocultural identity. Cases are presented here illustrating the use of ethnocultural identification as an auxiliary therapeutic tool to facilitate coping with changing cultural values and transitional experiences, and to promote the integration of the ethnocultural self into a consolidated sense of identity.

The therapist of color and the White patient dyad:Contradictions and recognitions.

The therapist of color and White patient dyad often involves contradictions and recognitions which are acknowledged through the specific processes and dynamics permeating this dyad. The relationship between self and other is frequently mediated through projection and identification. This article examines this unique interracial and interethnic therapeutic dyad emphasizing its clinical implications through the attribution of otherness, the use of colored screen projection, and the significance of power reversal. Special emphasis is given to the prevalent transferential and countertransferential reactions aided by clinical material. It is concluded that this therapeutic dyad provides a model for cross-cultural encounters where the resolution of contradictions can lead to the recognition of paradoxes, the acknowledgment of ambivalence, and the acceptance of disparate parts of the self.