Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology?

Article Abstract:

Antidepressant medications are used to treat a wide variety of psychiatric and mental disorders. Historically, it has been observed that different disorders that respond to treatment with the same drug or class of drugs (including vitamins) may share a common step in the physiological sequence of events that cause them. On the basis of an observed similarity of response of at least eight disorders to treatment with four classes of antidepressants, the authors propose that these conditions constitute a spectrum of a disorder with a shared origin. A review of the medical literature was undertaken which focused on the diagnosis and treatment of major depression, bulimia, panic disorder, obsessive-compulsive disorder, attention deficit disorder (hyperactivity), cataplexy (loss of muscle control as a reaction to strong emotion), migraine, and irritable bowel syndrome. The responses of each of these conditions to antidepressants, tricyclic, monoamine oxidase inhibitors, serotonin uptake inhibitors, and atypical agents, were rated along a five-point scale. A model was developed which suggests criteria for similarity of response to antidepressants. Other disorders, such as posttraumatic stress disorder and atypical facial pain, did not quite meet these criteria. Criticisms of the model and its assumptions are discussed. Four predictions are developed for future use in validating the assignment of the eight disorders to a single spectrum: there should be a greater than average prevalence of major affective disorders (depression) in individuals with cataplexy; relatives of patients with cataplexy, irritable bowel syndrome, obsessive-compulsive disorder, or migraine should exhibit a greater incidence of major affective disorder; serotonin uptake inhibitors will be effective therapy for hyperactivity, migraine, and irritable bowel syndrome; and the disorders in the spectrum will be found to share a common physiological abnormality. According to the authors, if these predictions are borne out, affective spectrum disorder could be considered one of mankind's most common psychological disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Physiological aspects, Affective disorders, Mood disorders, Physiology, Pathological, Pathological physiology

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Elevated antidepressant plasma levels after addition of fluoxetine

Article Abstract:

Fluoxetine is an antidepressant which has recently been approved for commercial use in the United States. When used alone, it appears to have relatively few side effects, but recent observations indicate that it may produce undesirable complications when used in combination with other psychotropic drugs used in treating mental disorders. An evaluation was made of a very small group of patients who were taking another antidepressant in conjunction with fluoxetine. Blood plasma levels were taken before and after fluoxetine treatment in four patients who were also taking tricyclic antidepressants and in one who was treated with trazodone. Any conclusions are limited by the group's small size and the fact that the data were not derived from a designed experiment, but from observations of records. The group was not homogeneous and the dosage of fluoxetine in each patient varied. These patients all showed higher levels of the other antidepressant in their blood plasma after treatment with fluoxetine. The authors suggested there is a possibility that fluoxetine affects the metabolism of these other antidepressants and consequently, may create potentially serious side effects. Though the researchers stressed the preliminary nature of the assumption, this observation was considered significant because the combination of antidepressants is quite common in clinical practice. The mechanism of fluoxetine is still unknown as are repercussions when it is accompanied by other antidepressants. The purpose of this article was to alert physicians to the possibility of this side effect and to stimulate further study of the drug.

Health aspects, Case studies, Complications and side effects, Drug therapy, Fluoxetine, Drug interactions

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Psychiatrists' attitudes toward dissociative disorders diagnoses

Article Abstract:

A suvey of board-certified psychiatrists concerning attitudes toward the dissociative disorders diagnoses in the DSM-IV is discussed.

Diagnosis, Beliefs, opinions and attitudes, Letter to the Editor, Psychiatrists, Dissociation (Psychology), Dissociative disorders

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