This study was designed to compare the therapeutic and adverse effects of tranylcypromine (a monoamine oxidase inhibitor), nortriptyline (a tricyclic antidepressant), and placebo. A total of 122 depressed outpatients randomly assigned to double-blind treatment with one of these agents completed the 4-week protocol. Treatment groups were balanced for proportions of endogenous versus nonendogenous depressions, defined according to the Research Diagnostic Criteria; however, nonendogenous depressions outnumbered endogenous depressions by such a large proportion (4:1) that meaningful statistical comparisons were limited to the nonendogenous group. In this group, both active drugs proved more effective than placebo, with little differences between the two active drugs except in the areas of side effects and of differential sensitivity of the outcome scales to a given drug. It was concluded that tranylcypromine, a drug which has received relatively little use and study in recent years, represents an effective and reasonably safe treatment for nonendogenous depression, although significant advantages over tricyclics with this disorder remain to be demonstrated.

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This study was undertaken to further assess the integrity of the hypothalamic pituitary axis using a combined GnRH-TRH test in diabetic male patients, with and without impotence. Furthermore, the stimulation test was performed before and after continuous insulin infusion in an attempt to acutely control the hyperglycemia in diabetic patients and to achieve near normal values of plasma glucose during the study. Patients and MethodsStudy Subjects: A group of 9 insulin treated diabetic male patients, age 19-39 years, attending the diabetic outpatient clinic at the Los Angeles County University of Southern California Medical Center participated in the study. The patients were free of intercurrent illness, and were on no medications except insulin. With the exception of patient number 5, who received a combination of semilente and lente insulins, all other patients were on NPH (Neutral Protamine Hagedorn) insulin once a day. There were no clinical features of laboratory evidence of ketosis, and the patients were in stable diabetic control. There was no evidence of other illness, such as eunuchoidism, hypothyroidism, hemochromatosis, liver disease or renal disease. Every patient underwent a complete physical and neurological examination to detect peripheral neuropathy, postural hypotension and peripheral vascular disease. Four of this group of patients had symptoms of sexual dysfunction mani-

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