Low dose desipramine treatment of cocaine-related panic attacks

Article Abstract:

It has recently been reported that cocaine use can trigger panic attacks, and that these attacks may continue even after cocaine is no longer used. During a panic attack, the person feels intense anxiety and fear, typically accompanied by physical symptoms such as nausea and sweating. Surprisingly, when patients with cocaine-related panic disorder have been treated with medications that normally reduce anxiety (tricyclic antidepressants), they have experienced heightened anxiety. The dosage of such medications may be critical, however; the authors have successfully treated such patients with ultra-low-dose tricyclic antidepressants. In this article, they describe 13 patients who had panic disorder that began during or soon after their cocaine use (12 weeks on average); when treatment began all the patients had stopped using cocaine because of the panic attacks. The patients were treated with ultra-low initial doses of the tricyclic antidepressant desipramine (2.5 to 10 milligrams per day). The dosage was gradually increased to an average of 25 milligrams per day. Two patients withdrew from the program after starting treatment, but the 11 remaining patients responded well to the medication after they were able to tolerate an increase in anxiety as they began treatment. This initial increase in anxiety was managed with relaxation techniques and, if necessary, a reduction of the desipramine dose. All 11 patients eventually experienced great improvement in their panic symptoms, and for nine (82 percent), the attacks resolved completely. The authors acknowledge that behavioral interventions, such as relaxation techniques, may have contributed to the patients' improvement. The possible neurological mechanisms that could explain the relationships among cocaine, panic attacks, and tricyclic antidepressants are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Physiological aspects, Drug therapy, Cocaine abuse, Panic disorders, Panic disorder, Cocaine, Antidepressants, Tricyclic, Tricyclic antidepressants, Desipramine

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Psychiatric syndromes linked to reproductive function in women: a review of current knowledge

Article Abstract:

Four psychiatric disorders involving women's reproductive function are postpartum depression, premenstrual syndrome (PMS), post-hysterectomy depression, and involutional melancholia (menopausal depression). The understanding of psychiatric syndromes that are linked to women's reproductive function has been clouded by myths, incorrect assumptions and research data based on unscientific methodology. This article reviews the results of newer, better studies in order to update present knowledge of each syndrome. Postpartum depression ranges in severity from brief emotional lability and tearfulness to severe psychotic depression. Psychiatric hospital admissions are substantially higher for women in the first three postpartum months and slightly higher for up to two years after uncomplicated childbirth. PMS has received much attention, but is poorly understood because it is difficult to study objectively. Wide variation in symptoms, their severity and their duration has caused controversy over the proper definition of PMS. Treatments are as yet experimental, but include exercise, reduction of salt and caffeine intake and, if necessary, medications for specific symptoms. The existence of post-hysterectomy depression is no longer supported by research data; there is minimal evidence that hysterectomy results in an elevated rate of depression. Experts now also believe that menopausal depression is a mythical condition.

Research, Menopause, Hysterectomy, Premenstrual syndrome, Women patients, Postpartum psychiatric disorders

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A psychiatrist's reaction to a patient's suicide

Article Abstract:

The response of a psychiatrist to a patient's suicide is discussed in a clinical case conference. The incident occurred relatively early in the psychiatrist's career, which may have made it more difficult.

Statistical Data Included, Case studies, Suicide, Psychiatrists, Therapist-patient relations, Psychotherapist and patient

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