MarkS. Gold

CLONIDINE BLOCKS ACUTE OPIATE-WITHDRAWAL SYMPTOMS

In a double-blind, placebo-controlled, cross-over trial, clonidine eliminated objective signs and subjective symptoms of opiate withdrawal for 240--360 min in eleven addicts in a hospital setting. In an open pilot study of the effects of clonidine on longer-term opiate abstinence and symptoms, the same patients did well while taking clonidine for one week. There was only one documented instance of heroin use, in a patient who did not take clonidine after hospital discharge. 6 weeks or more after the study, four patients were back on reduced doses of methadone, one was on tricyclic antidepressants, and seven were off of all opiates. All eleven patients were doing well. These data suggest that opiate withdrawal is due to increased neuronal activity in areas such as the locus coeruleus which are regulated by both alpha-2 adrenergic and opiate receptors.

The TRH test in the diagnosis of major and minor depression.

Abstract (1) The effect of TRH on TSH and GH release was studied in 144 consecutive psychiatric admissions. The magnitude of the TSH response to TRH differentiated unipolar from clinically similar and dissimilar groups. (2) Of 41 patients with unipolar depression, 31 had a ΔTSH of ≤7 μI.U./ml while only 1 of 12 bipolar and 0 of 10 minor depressive patients had a ΔTSH of ≤7 μI.U./ml. (3) A ΔTSH of ≤7 μI.U./ml is a frequent finding in unipolar depression and infrequently associated with other psychiatric diagnoses. (4) The data reported support the hypothesis that patients with a ΔTSH of ≤7 are unipolar depressives. (5) Six of 12 bipolar and 17 of 41 unipolar depressives had a GH response to TRH while none of the patients with a minor depression had a significant GH response. These data suggest that major and minor depressions can be separated on the basis of the TRH-induced GH response test. (6) The magnitude of the TRH-induced TSH response and the presence of a pathological GH response may be extremely useful in differentiating manics from schizophrenics and other similarly appearing patient groups. (7) The TRH test is useful in clinical differential diagnosis of dysphoric states and as a confirmatory laboratory test for major depressive disease and unipolar depression.

TRH-induced TSH response in unipolar, bipolar, and secondary depressions: Possible utility in clinical assessment and differential diagnosis

Abstract (1) The effect of TRH on TSH and GH release was studied in 32 depressed patients. (2) Patients were diagnosed as having a primary (unipolar or bipolar) or secondary depression and rated with Hamilton ratings at the time of TRH testing. (3) The magnitude of the TRH-induced TSH responses significantly differentiated unipolar and bipolar depressed patients who had similar symptoms, cortisol secretion, and Hamilton ratings. (4) GH responses to TRH were only observed in primary affective, depressed patients. (5) The fact that bipolar depressives had augmented TSH responses while unipolar patients had blunted TSH responses supports the clinical differentiation of these patients and suggests that different neurobiological factors may be involved in these clinically similar states. TRH-induced TSH response may ‘switch’ from augmented to blunted as the patients clinical state changes from depressed to manic. (6) The neural mechanism mediating these TRH test data is difficult to discern on the basis of current studies reported in the literature.

Survey of 500 callers to a national cocaine helpline

Abstract Information gathered during extensive telephone interviewing of 500 cocaine users calling the 800-COCAINE helpline revealed a high incidence of dysfunctional cocaine use associated with numerous physical, psychological, and social problems. The typical caller was a white, middle-income male between 25 and 40 years old with no history of drug dependence or serious psychiatric problems. The findings are discussed with regard to the high abuse potential of cocaine and adverse effects.