Stephen L. Stern

Gender differences in quality of life among cardiac patients.

Objective Prior studies of quality of life among cardiac patients have examined mostly men. This study evaluated gender differences in quality of life and examined the degree to which social support was associated with quality of life. Methods A sample of 536 patients (35% women) was recruited during a 14-month period from the inpatient cardiology service of a University-based hospital. Participants completed assessments at baseline and at 3-month intervals over the subsequent 12 months, for a total of 5 assessments. Measures at each assessment included quality of life [Mental Component Score (MCS) and Physical Component Score (PCS) from the Medical Outcomes Study—Short Form 36] and social support [Interpersonal Support Evaluation List—Short Form]. Results A total of 410 patients completed the baseline assessment and at least one follow-up, and were included in the data analyses. Linear mixed effects modeling of the MCS score revealed a significant effect of gender (p = .028) and time (p < .001), as well as a significant interaction of gender by social support (p = .009). Modeling of the PCS revealed a significant effect of gender (p = .010) and time (p < .001). Conclusions Women with cardiac disease indicated significantly lower quality of life than men with cardiac disease over the course of a 12-month longitudinal follow-up. Social support, especially a sense of belonging or companionship, was significantly associated with emotional quality of life (MCS) among women. Strategies to increase social support may be important for health and well-being of women with cardiac disease.

The Dysfunctional Attitude Scale : how well can it measure depressive thinking ?

The Dysfunctional Attitude Scale (DAS) was designed to measure patterns of maladaptive thinking held by depressed individuals. Despite its wide use as a research and clinical tool, only a few studies to date were designed to examine its psychometric properties in a clinically depressed population. Moreover, problems of low sample size and limited tests of validity call these findings into question. The present study was designed to examine psychometric properties of the DAS in clinically depressed inpatients and in nondepressed clinical controls. Intertest correlations between the DAS parallel forms and between each form with total test scores ranged from r=.84 to r=.97. Intratest stability coefficients were r=.88 to r=.97. Support for the DAS as a valid measure of dysfunctional cognitions in depressed patients was also indicated. Of those scoring high on the DAS, 73% received an independent RDC diagnosis of clinical depression, while only 36% of those receiving low DAS scores were so diagnosed.

Mood induction in a clinically depressed population

Mood induction paradigms have become particularly useful in isolating and examining the relationship between mood and cognition relative to depressive vulnerability. The relationship between these two variables was examined using a 2 × 4 design (Diagnostic Group × Condition) whereby subjects classified as depressed (N=72) and nondepressed (N=61) were assigned to one of four conditions. It was shown that the cognitions of clinically depressed individuals were more dysfunctional than those of nondepressed subjects and that they can undergo temporary states of elation in the absence of any significant change in depressive cognition. How these results relate to cognitive theories of emotion is discussed.

2-HYDROXYDESIPRAMINE AND DESIPRAMINE PLASMA LEVELS AND ELECTROCARDIOGRAPHIC EFFECTS IN DEPRESSED YOUNGER ADULTS

Desipramine was given to 34 outpatients aged 20 to 51 years who had primary major depressive disorder but who were otherwise in good health. Daily dosage at bedtime was constant for the final 3 weeks of the 5-week study (mean, [SD] 169.1 [46.1] mg). Electrocardiograms done predrug and after 5 weeks were read by a cardiologist blind to the order in which they were performed. Plasma samples drawn 14 hours after the final study dose were assayed by high performance liquid chromatography; mean (SD) levels were 140.2 (140.0) ng/ml for desipramine and 56.5 (29.4) ng/ml for 2-hydroxydesipramine (2-OH-DMI). Heart rate and PR, QRS and QTc intervals were significantly greater at the end of the study than at baseline, while QT intervals were significantly less. Changes in heart rate and PR, QT and QTc intervals were significantly negatively correlated with the value of the respective cardiac parameters at baseline. Changes in PR interval were significantly positively correlated with log desipramine, log 2-OH-DMI and log (desipramine + 2-OH-DMI). Stepwise multiple regression analyses showed that, for PR interval, each of the three plasma level variables showed a significant ability to improve R2 over that obtained from baseline PR alone. These findings suggest that both 2-OH-DMI and desipramine plasma levels predict a prolongation of intracardiac conduction in younger adults and that monitoring both levels may be useful in the clinical management of certain younger adult patients.

Premenstrual syndrome: concerns, controversies, and treatment.

Premenstrual syndrome is of interest to health care professionals today because of media attention and large numbers of women who are concerned about their premenstrual symptoms. At the same time, there is a lack of consensus as to diagnostic criteria and specific treatment. There appears to be a relationship between mood disorders such as major depression and luteal phase symptoms. An approach to the diagnosis and treatment of the patient with premenstrual syndrome is described.

Reduced serum tricyclic levels due to gel separators

Sixty-three blood samples were obtained from 48 subjects taking tricyclic antidepressants. Samples were simultaneously collected in Becton-Dickinson Vacutainer tubes for measurement of serum and plasma tricyclic antidepressant concentrations. Serum was drawn into red stopper tubes (without gel separator) and into speckled stopper serum separator tubes (with gel separator), while plasma was collected in green stopper tubes (heparinized). Imipramine, desipramine, amitriptyline, and nortriptyline concentrations were all significantly lower in serum separator samples than in either plasma or red stopper serum collection tubes. Serum and plasma concentrations were similar.

2-Hydroxydesipramine and desipramine plasma levels : how are they related to antidepressant response?

Thirty-six outpatients aged 20 to 51 with RDC primary major depressive disorder (MUD) completed a 5-week trial of desipramine following a week of single-blind placebo. Five had a past history of hypomanic disorder. For all but one patient, daily dosage at bedtime was constant for the final 4 weeks, with a mean (S.D,) of 168.1 (46.5) mg, Plasma samples drawn at the three final weekly visits were assayed by high-performance liquid chromatography for 2-hydroxydesipramine (2-OH-DMI) and desipramine. Mean (S.D.) plasma levels were 59.8 (30.0) ng/ml for 2-OH-DMI and 142.9 (138.6) ng/ml for desipramine. Thirteen patients (36%) had a final 17-item Hamilton depression rating ≤ 6 and were classified as responders. According to receiver operating characteristics analysis, patients with plasma 2-OH-DMI levels ≥ 58 and <92 ng/ml had a greater likelihood of responding than those with lower or higher levels (p = 0.005, Fishers exact test), while patients with plasma desipramine levels ≥ 64 ng/ml were more likely to respond than those with lower levels (/> = 0.032, Fishers exact test). Results using an alternate response criterion were similar. These findings suggest that in desipramine-treated outpatients with primary MDD the relationship between therapeutic response and plasma levels is curvilinear for 2-OH-DMI and linear for desipramine.

Drug combinations in the treatment of refractory depression: a review

The authors critically review several drug combinations that may be of promise in the management of depressions that do not respond to treatment with a single drug. These include the use of tricyclic antidepressants with monoamine oxidase inhibitors (MAOIs), L-triiodothyronine (T3), methylphenidate, lithium carbonate, L-tryptophan, reserpine, and neuroleptics; MAOIs with lithium and L-tryptophan; and L-tryptophan with allopurinol. The authors stress the need for further double-blind, controlled studies to evaluate the safety and efficacy of these combinations.