Nicholas A. Votolato

Amino Acid Supplementation as Therapy for Attention Deficit Disorder

A double-blind study compared the effects on 14 children with attention deficit disorder (ADD) with hyperactivity of 1-week trials of each of the following: tyrosine 140 mg/kg/day, tryptophan 100 mg/kg/day, d -amphetamine 5 mg or 10 mg/day, and placebo. Parent and teacher ratings and measures of attention were obtained at baseline and at the end of each condition. Tyrosine was not significantly different from placebo on any of the variables measured. Tryptophan, while not significantly different from placebo on teachers ratings, was significantly better by parents ratings. This suggests that tryptophan may have some benefit in selected cases of ADD, primarily with home behavior problems.

The effect of α-2 adrenergic agonists on memory and cognitive flexibility

BackgroundThe noradrenergic system modulates cognitive flexibility for insight-based problem solving in studies using β-adrenergic antagonists, which block noradrenergic neurotransmission postsynaptically. However, it is not known whether α2-adrenergic agonists, that decrease noradrenergic neurotransmission by presynaptic inhibition, have the same effect. ObjectivesTherefore, we wished to test whether α2-adrenergic agonists would have a similar effect on cognitive flexibility. MethodsEighteen normal adults were tested on cognitive flexibility, problem solving, verbal and spatial memory tasks after receiving clonidine (0.1 mg), an α2-agonist, placebo, or ephedrine (25 mg), a noradrenergic stimulant. ResultsThree-way analysis of variance revealed no significant drug effect on cognitive flexibility or problem solving. There was also no significant effect of clonidine on memory. ConclusionsTherefore, α2-agonists do not influence cognitive flexibility in the same manner as β-antagonists. Better performance on memory with clonidine might be expected based on primate studies demonstrating benefits in working memory using clonidine. This benefit was not observed for the commonly used clinical memory tasks in our study. This may have implications for why clonidine has not demonstrated efficacy for cognitive disorders such as Alzheimer disease, despite its known benefit for working memory in animal models.

Myoclonus, hyperreflexia and diaphoresis in patients on phenelzine-tryptophan combination treatment.

Three cases are presented on patients on an MAOI who developed a transient syndrome of myoclonus, hyperreflexia, jaw quivering, teeth chattering and diaphoresis after L-Tryptophan was added. Caution is advised when considering the addition of a serotonergic agent to MAOTs.

Clinical correlates of valproate augmentation in refractory bipolar disorder.

We examined the clinical correlates of valproate (VPA) therapy in refractory bipolar disorder. Retrospective chart review was used to collect demographic and clinical data including present diagnosis, diagnosis at illness onset, duration of illness, number of hospitalizations, VPA dose, side effects, and maximum serum concentration. Global response was rated once patients serum VPA exceeded 50 mg/dL. The charts of all inpatients admitted over a two-year period and treated with VPA for acute episodes of bipolar disorder in manic, mixed, or depressed phase were reviewed. Seventeen of these patients began VPA augmentation while hospitalized and became the cohort for review. Patients were excluded if VPA was started prior to admission or the patient was discharged less than one week after drug initiation. Patients were not excluded on the basis of EEG, CT, or neurological exam findings. Overall, 12 of 17 (71%) of the patients showed a moderate or marked improvement while 5 of 17 (29%) showed mild or no response. Responders were older and had a longer duration of illness with an increased number of hospitalizations. There was a strong trend for responders to achieve a higher serum VPA level. A significant positive correlation was found between response in acute mania and psychotic symptoms at first episode of illness.

Elevated defibrillation threshold with venlafaxine therapy.

Depression is a common comorbidity in patients with heart failure or implantable cardioverter‐defibrillators (ICDs). A 35‐year‐old woman with depression, nonischemic cardiomyopathy, and a history of cardiac arrest had an ICD implanted. During initial testing, the device failed to internally defibrillate the patient. Venlafaxine, an antidepressant with cardiac sodium channel blocking activity, was identified as a potential contributor to her elevated defibrillation threshold. After the venlafaxine was discontinued, the ICD was able to successfully internally defibrillate the patient. Clinicians should be aware of this potential adverse drug‐device interaction. Further studies are needed to determine the clinical significance of venlafaxine therapy in patients with ICDs.

The successful use of right unilateral ultra-brief pulse electroconvulsive therapy in an adolescent with catatonia

Right unilateral ultra-brief electroconvulsive therapy (RUL UB ECT) has been shown to be efficacious with minimal cognitive adverse effects in adult patients with major depression. We present the case of a 14-year-old girl with major depressive disorder with catatonic and psychotic features whose symptoms remitted after 12 treatments of RUL UB ECT.