Sieglinde C. Othmer

BRAIN FUNCTIONS AND PSYCHIATRIC DISORDERS: A Clinical View

Psychiatric disorders are viewed as brain disorders affecting five circuits of the brain: the brainstem, the hypothalamus, the motor striatum, the limbic system (ventral striatum), and the neocortex. This five-circuit model combines neuroscientific, psychopharmacologic, evolutionary, introspective, and behavioral data. The article presents a broad speculative overview of some brain functions and dysfunctions relevant for clinicians.

Tricyclic-induced electroencephalogram abnormalities and plasma drug concentrations.

In a double-blind study of 34 randomly assigned depressed inpatients, antidepressant-induced electroencephalogram (EEG) abnormalities were compared in amitriptyline-treated versus bupropion-treated patients. Drug-free baseline EEGs plus one or more repeat EEGs under pharmacokinetic steady state conditions were obtained. Of the 34 patients, eight developed EEG abnormalities. Seven were on amitriptyline and one was on bupropion (x2 = 13.77, df = 3, p < 0.01). All but one of the amitriptyline-treated patients with EEG abnormalities had plasma concentrations above its therapeutic range (150 to 250 ng/ml), whereas all with normal EEGs were within or below this range.

Problems in the Treatment of the Chronic Depressive

Antidepressants are effective in the treatment of acute depressive episodes. Their efficacy for more chronic forms of depression however, has not been clearly established. Therefore, the evaluation of the efficacy of established and novel antidepressants for the treatment of chronic depression is of clinical interest.