Returning to tricyclic antidepressants for depression during childbearing: clinical and dosing challenges

Managing depression and anxiety during pregnancy and the postpartum period is challenging. Both pharmacological treatment and the lack thereof can pose threats to a fetus. SSRIs are the drugs of choice for use during pregnancy, but there is considerable evidence for the safety and efficacy of older antidepressants during pregnancy as well. This study highlights a single case of the use of the tricyclic nortriptyline during pregnancy and postpartum. The subject involved had an unexpectedly high ratio of serum level to drug dose during the postpartum period. We monitored the subject for a significantly greater portion of the postpartum period than has been done in previous studies, and explored medical and lifestyle changes that could account for the level-to-dose ratios we observed. Differences in smoking patterns, coupled with the patient’s status as a genetic poor metabolizer, were the most likely explanations.     

A roleplaying test for the assessment of interpresonal styles

The Improvisation Test for Individuals (Impro-I) consists of 12 roleplays that represent a variety of interpersonal situations. Performance is evaluated by observers. Forty-seven Ss were examined by two test teams in order to evaluate the reactions of the Ss to the roleplays and to determine interrater reliabilities. Ss found the roleplays generally realistic and their own performances lifelike. Interrater reliabilities were moderate to high.     

Decrease of brain extracellular fluid [Na] and its interaction with other factors influencing sodium appetite in sheep

It has been shown previously in sheep that physiological increase of cerebrospinal fluid (CSF) [Na] by infusion of 0.5 M NaCl artificial CSF causes a large reduction of sodium appetite of the sodium-deplete animal. Equivalent increase of CSF osmotic pressure caused by infusion 0.7 M mannitol artificial CSF which lowers CSF [Na] causes a doubling of sodium appetite. The results of the experiments here show that simple dilution of CSF [Na] with isotonic mannitol CSF, as distinct from use of hypertonic 0.7 M mannitol CSF, is an equally effective strong stimulus of sodium appetite. Lowering CSF [Na] concentration stimulates salt appetite in the severely sodium-deplete as well as in the mild to moderately sodium-deplete animal, and the effect of decrease of CSF [Na] on sodium appetite is sustained over 48 h. In addition, i.c.v. infusion of angiotensin II for the preceding 22 h at a rate which is an effective stimulus of both water and sodium solution intake in the sodium-replete animal, in fact, significantly decreased the sodium appetite stimulating effect of reduction of CSF [Na] in the Na-deplete animal.     

Scimitar etcetera--the dysmorphic right lung

'Dysmorphic lung' is introduced as a term to describe any complex congenital malformation which involves both abnormal vascular morphology and disordered growth of a whole lung. The major group within this definition is the scimitar syndrome, which we choose to mean a hypoplastic lung with anomalous venous drainage and various degrees of collateral arterial supply. Nine typical cases of scimitar are presented, with three closely related cases. Six other cases of dysmorphic lungs are also present. The relationships between the groups are discussed, and an effort is made to clarify the nomenclature used in this condition.     

Linear transformation and the interpretation of MMPI T scores

Raw scores for the clinical scales of the MMPI can be changed to T scores by linear transformation. However, if the underlying distributions of raw scores are not distributed normally, one cannot assume that the traditional point of significance, T score 70, falls at the 97.7 percentile. Our analysis of the improved Minnesota normal sample described by Hathaway and Briggs in 1957 revealed statistically significant degrees of skewness on most of the clinical scales. We suggest that clinicians consider more conservative interpretation for scales 1 (Hs), 2 (D), 7 (PT), 8 (SC), and 9 (MA) for females and for scales 1 (Hs), 2 (D), 4 (PD), 7 (PT), 8 (SC), and 9 (MA) for males.     

Photoelastic assessment of the expansion of direct-placement gallium restorative alloys.

OBJECTIVE: The purpose of this study was to assess, via a photoelastic resin, the expansion of gallium restorative alloys under conditions similar to those found in the clinical situation. METHOD AND MATERIALS: Two gallium alloys, Galloy and Gallium GF II, were tested, along with a high-copper amalgam, Dispersalloy, and a low-copper alloy, New True Dentalloy. The gallium alloys were tested as (1) uncontaminated, (2) contaminated with water, Ringer's solution, or a cell culture medium, and (3) immersed in these fluids at times ranging from 5 minutes to 3 days. The gallium and amalgam alloys were condensed in a hole drilled in a block of photoelastic resin and observed for 3 months. The amount of stress was recorded on color slides taken through polarized light at regular intervals. The photographs of the color bifringen stress patterns at 1 and 3 months were ranked by two independent evaluators for least to greatest observed stress. RESULTS: Dispersalloy had the least expansion, followed by uncontaminated Galloy and Galloy contaminated with water. Next came Galloy contaminated with cell culture medium, Galloy contaminated with Ringer's solution, contaminated New True Dentalloy, and Gallium GF II. The last group was Gallium GF II contaminated with any of the three solutions. Both gallium alloys immersed in the three fluids showed a strong edge effect, and by 6 weeks many of the gallium alloys had extruded from the mold. CONCLUSION: These results corroborate the findings of some clinical studies that have shown that these gallium alloys can potentially cause catastrophic failures.     

Reduction in antiviral activity of human beta interferon by gallic acid.

Gallic acid (GA) is a common part of the human diet, both in the free form and as a metabolite of tannic acid and propyl gallate. Cell cultures were incubated with mixtures of either GA and beta interferon (IFN-beta) (formerly fibroblast IFN) or medium and IFN-beta. The cells were subsequently challenged with virus. The virus plaque yields were greater in cells incubated with IFN-beta and GA than in cells incubated with IFN-beta and medium, indicating that in the former mixture, IFN-beta had lost antiviral activity. The magnitude of the loss was dependent upon the GA concentration. IFN-alpha and IFN-gamma (formerly leukocyte IFN and immune IFN, respectively) were not similarly affected. The effect of GA on IFN-beta could be reversed with 2-mercaptoethanol, suggesting a possible sulfhydryl involvement. Extensive dialysis of IFN-beta-GA mixtures to remove the GA failed to reverse the reduction in antiviral activity. This suggests that a direct and irreversible interaction between IFN-beta and GA took place, reducing the activity of IFN-beta. The significance of this finding with regard to virus infections of the intestine is discussed.     

Pharmacogenetic methods in schizophrenia

Human variability in response to medication is an impediment to successful drug treatment, as it makes good clinical response and avoidance of side effects difficult to predict. Much of this variability is genetic in origin, as inheritance results in differences in the way drugs are metabolized and act on their receptors in the body. There are two possible ways of avoiding this, either by designing future drugs which are not subject to the vagaries of human metabolism, or by pharmacogenetics, i.e. determining those genetic factors which affect response. Pharmacogenetics looks for inherited differences between responders and non-responders (or those with and without a particular side effect) to a given medication so that the mechanisms of variability can be understood. Current research is aimed at developing prescribing strategies of the future which will use simple genetic tests to determine which drug is most suitable for a given patient.     

Postnatal maturational changes in rat pelvic autonomic ganglion cells: a mixture of steroid-dependent and -independent effects

Androgens have potent effects on the maturation and maintenance of a number of neural pathways involved in reproductive behaviors in males. Most studies in this area have focused on central pathways, but androgen receptors are expressed by many peripheral neurons innervating reproductive organs, and previous studies have demonstrated structural and chemical changes in these neurons at puberty and after castration. We have performed the first electrophysiological comparison of pelvic autonomic ganglion neurons in male rats before and after puberty and following pre- or postpubertal castration. Studies were performed in vitro on intact ganglia with hypogastric and pelvic nerves attached to allow synaptic activation of sympathetic or parasympathetic neurons, respectively. Pelvic ganglion neurons underwent many changes in their passive and active membrane properties over the pubertal period, and some of these changes were dependent on exposure to circulating androgens. The most pronounced steroid-dependent effects were on membrane capacitance (soma size) in sympathetic neurons and duration of the action potential afterhyperpolarization in tonic neurons. Our study also showed that rat pelvic ganglion cells and their synaptic inputs were more diverse than previously reported. In conclusion, this study demonstrated that rat pelvic ganglion neurons undergo considerable postnatal changes in their electrophysiological properties. The steroid dependence of some of these changes indicates that circulating androgens may influence reproductive behaviors at many locations within the nervous system not just in the brain and spinal cord.