Calcium-channel blockade and depressive illness

Article Abstract:

Calcium-channel antagonists (calcium blockers) act on muscles to prevent the constriction of blood vessels and also slow the passage of nerve signals through heart muscle. Initially prescribed to treat high blood pressure, there has been an increasing interest in their use for psychiatric disorders. One calcium blocker, verapamil, has been used to treat mania, while another, nifedipine, is reported to produce a paradoxical effect and induces mania or an elevated mood. A case is presented of a 67-year-old woman with a long history of recurrent depression and many hospitalizations who responded well when nifedipine was discontinued. A few days after her last admission to a psychiatric hospital, the woman had a sudden and unexplained spontaneous recovery. A review of the records showed that on the third day of hospitalization nifedipine was withdrawn because the patient developed low blood pressure. Clinical improvement was very rapid, and she was able to return home, where her mood remained quite elevated, but was still within a normal range; she was not hypomanic or manic. This rapid 'switch' from depression to elevated mood was also noted in another patient after nifedipine was withdrawn. A subsequent review of 45 patients admitted to the hospital with severe affective disorder revealed that four were taking nifedipine. Three recovered when the drug was withdrawn, but remained on various drug treatments. The fourth patient recovered after withdrawal of nifedipine alone. Various calcium-channel blockers are structurally different. The fact that verapamil does not bind to the same receptor as nifedipine would seem to explain why one stabilizes mood, while the other may precipitate a mood disorder. The data suggests that patients with treatment resistant depression who are being treated with nifedipine should be withdrawn from this drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nifedipine, Calcium channel blockers

---

Unresolved grief presenting with features of a negative therapeutic reaction

Article Abstract:

In 1917, Freud compared mourning and melancholia (depression). He observed the two conditions to be almost identical, but stressed that in melancholia there was an added dimension of low self-regard, self-reproach, and the expectation of punishment. He pointed out that in mourning the world becomes empty, but in melancholia, unexpressed anger towards the person who died is directed inward to the portion of the survivor's ego that identified with the deceased. The case report is presented of a deeply religious woman who, after becoming widowed at age 39, was unable to resolve her grief reaction, which manifested in a five-year period of depression, weeping episodes, insomnia, nightmares, and poor concentration. In psychotherapy, she began to explore childhood feelings of emptiness that had returned after her husband's death. She revealed that her husband had been partially paralyzed and she felt betrayed because he had lied to her about his impotence before their marriage. They adopted two children, but the youngest child was mentally and physically handicapped, and was eventually placed in a residential home. During therapy, each time her symptoms abated, her depression soon returned in full force. This was interpreted as a negative therapeutic reaction. It was pointed out to her that when she felt well, she believed she was betraying her husband. Therapy eventually revealed that the woman had strong ambivalent feelings toward her husband; each time her condition improved, she became guilty over the hostility and resentment she felt for him. She also had unresolved guilt and shame about her handicapped daughter. As the patient became aware of these conflicts, her symptoms lessened. Ten months after therapy ended, the woman remained asymptomatic and planned to remarry. (Consumer Summary produced by Reliance Medical Information, Inc.)

Grief, Psychotherapy patients

---

Anterior tumour of the corpus callosum with atypical depression

Article Abstract:

The forebrain consists of a central core and a right and left cerebral hemisphere. Largely separated by a longitudinal division, the hemispheres are connected by a structure known as the corpus callosum. The case report of a 55-year-old woman with atypical depression and a tumor of the anterior corpus callosum is presented. She was admitted to the hospital after four weeks of increasing withdrawal and inability to care for herself. Her family reported that she had lost weight, was increasingly uncommunicative and hopeless. A previous depressive episode had occurred 10 years earlier. On the ward her moods were labile and she became silly at times. The patient was disoriented with regard to time, but knew where and who she was. Recent memory was poor, although memory for the remote past and general knowledge were normal. Computerized tomography revealed a large tumor of the corpus callosum invading both frontal lobes. Tissue biopsy showed the tumor to be a glioma. Similar tumors usually are accompanied by early mental symptoms, which progresses to dementia. Typical frontal lobe tumor symptoms include loss of recent memory, indifference to environment, personality changes, confusion, apathy, drowsiness, and coma. This patient was unusual in that depression was a prominent early symptom. In this case, an organic brain syndrome was suspected because of the patient's short-term memory loss and time disorientation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Brain tumors

Similar abstracts:

• Abstracts: Bronchial hyperresponsiveness to methacholine in patients with impaired left ventricular function. Improvement in exercise performance by inhalation of methoxamine in patients with impaired left ventricular function
• Abstracts: Calcium, magnesium, zinc, and iron balances in young women: effects of a low-phytate barley-fiber concentrate
• Abstracts: Concealed progress in the management of severe surgical infection. Association of cytomegalovirus infection with increased morbidity is independent of transfusion
• Abstracts: Elective radical neck dissection in epidermoid cancer of the head and neck: a retrospective analysis of 853 cases of mouth, pharynx, and larynx cancer
• Abstracts: The historical evolution of the concept of negative symptoms in schizophrenia. The concept of negative symptoms

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.