No abstract

The therapeutic efficacy of lithium added to tricyclic antidepressants (TCA) or related thymoleptics was investigated in 27 endogenous depressive patients responding unsatisfactorily to these drugs alone. All patients received lithium during two weeks, however, with a delay of one week in 13 of them, the attribution to active treatment or placebo for the first seven days being double-blind. A statistically significant improvement compared to placebo occurred after lithium addition. The results of the double-blind part of the study as well as the observations during the total two-week period suggest that endogenous depression failing to respond to thymoleptic drug treatment can be improved within a short time by the co-administration of the two treatments in the indicated sequence. However, the proportion of patients improved and the rapidity of improvement noted in this study were less favorable than reported by the investigators who discovered the therapeutic principle.

In order to evaluate the effect of head injury in severely traumatized patients on the response of plasma cortisol, glucagon, insulin, glucose, and FFA as well as urinary N and catecholamines excretions, 36 patients were prospectively studied over 5 consecutive days following injury. They were divided into three groups: group I, severe isolated head injury (n = 14); group II, multiple injury combined with severe head injury (n = 12); group III multiple injury without head injury (n = 10). The results demonstrate similar hormonal and metabolic changes between these three groups of patients, characterized by elevated urinary adrenaline, noradrenaline excretion, increased cortisol, glucagon, insulin plasma levels throughout the study and elevated N urinary excretion with strongly negative N balances during the first 5 days postinjury. A significant correlation was observed between N intake and 5 day cumulated N balance (r = 0.63, p less than 0.001). In addition, N balance was negatively correlated with urinary excretion of adrenaline (r = -0.47, p less than 0.01) and noradrenaline (r = -0.44, p less than 0.05) as well as plasma levels of glucagon (r = -0.44, p less than 0.05). Isolated severe head injury seems to induce a full response in the secretion of the catabolic counterregulatory hormones comparable to that encountered in patients with multiple injury and associated with a marked increase in protein catabolism; additional noncranial major injury does not seem to enhance these responses.

No abstract

Concentrations of TSH, TRH-induced TSH (delta-TSH), T4, FT4, T3, and FT3 were investigated in 20 patients resistant to antidepressants before and after one week of lithium addition. TSH and delta-TSH increased, whereas FT4 and FT3 decreased statistically significantly during this treatment, indicating a slight lithium-induced hypothyroid function. A statistically significant correlation between improvement and the FT3/FT4 ratio after seven days of lithium addition was found. Also, an increase or only a small decrease in FT3 and an augmenting FT3/FT4 ratio during lithium addition were correlated with a favorable outcome. Besides the possibility that a high relative FT3 concentration is an indicator of an unknown somatic condition favorable for improvement, this finding might be directly related to treatment response. It appears conceivable that even within the normal range a sufficient T3 concentration is necessary for an optimal response to lithium addition.