The writers of this paper made an inventory of the studies on the use of thyroid hormone in the treatment of depression. Fifteen clinical trials (353 patients), published between 1969 and 1987. were found, that can be described, as to their design, in two seperate groups:

One group (7 studies) administers thyroid hormone simultaneously with a tricyclic antidepressant to reach a faster effect of the antidepressant. The other group (8 studies) adds thyroid hormone to a tricyclic antidepressant in patients who fail to respond to this treatment, with the aim to convert therapeutic failure to success. After studying the literature we think we are able to conclude that it can be usefull to combine the antidepressant with thyroid hormone in view of the fact that, in a number of depressed patients, it shortens the duration of the illness. The augmentation of tricyclics by thyroid hormone needs further study.

Several studies have demonstrated that psychomotor retardation is an important sign of the major depressive episode, both from a diagnostic point of view and as a predictor of treatment outcome. However, it is uncertain to what extent psychomotor retardation is specific for the major depressive episode. A heterogeneous group of psychiatric patients (n=26) was studied using a rating scale developed specifically to assess psychomotor retardation (RRS). The 13 patients suffering from a major depressive episode had a significantly higher RRS score than patients with another diagnosis. Furthermore, in the depressive subjects the severity of the depression (measured by means of Hamilton's depression rating scale) appeared to correlate with the severity of the psychomotor retardation. Cognitive features of psychomotor retardation were mainly responsible for the more severe psychomotor retardation in the depressive patients. Surprisingly. Hamilton's depression scale which was used in this study does not pay much attention to these aspects.

The controversy concerning the concept ‘alcoholic dementia’ is reviewed in brief. Evidence from neuroradiological and neuropathological studies contribute little to the solution of this controversy, if dementia is considered as a clinical syndrome. From clinical descriptions it can be concluded that a sub-population of alcoholics suffers from a syndrome typified by psychologic disturbances other than amnesia alone. These patients fulfill the criteria for the syndromal diagnosis of ‘dementia’.

The nosologic concept of ‘alcoholic dementia’ implies a direct neurotoxic effect of alcohol and it raises questions concerning pathogenetic mechanisms which can not be answered. The DSM-III-R category ‘dementia associated with alcoholism’ represents a solution for this controversy, because it gives a correct and complete (radically syndromal) clinical description without making assumptions on the relative contribution of multiple factors causing cognitive disturbances in alcoholics.

Lithium was added to imipramine in case of a 55-year old depressed woman who didn't respond to imipramine alone. There was a clear improvement within a few days on 900 mg lithium carbonate a day (lithium plasmalevel 0.9 mmol/l). However when after two weeks the lithium dose was reduced to 600 mg a day (lithium plasmalevel 0.5 mmol/l), an almost immediate relapse followed. On resuming lithium in the old dose the depression disappeared again. After four weeks the second attempt at reducing and eventually stopping the lithium appeared to be successful. Half a year after cessation of lithium imipramine was also stopped. More than a year afterwards there hasn't been a depression again.

In this case, after a fast potentiation of imipramine by lithium, a relapse followed when the lithium dose was reduced. It seems to be that even a high and successful starting dose of lithium needs to be continued for some time in order to prevent a relapse.

In deze rubriek zal worden ingegaan op recente observaties betreffende de psychofarmakologie in de breedst mogelijke zin. Vaak zullen zaken uit de Literatuur worden behandeld. De gekozen onderwerpen dienen altijd klinische relevantie te hebben. Ook zal deze rubriek gaan over gewoontes die in psychofarmakologische behandeling of in onderzoek zijn geslopen die volgens de auteur lang niet altijd logisch zijn. Soms zal deze rubriek een oproep bevatten om te reageren op een bijdrage gepubliceerd in dit of in een ander tijdschrift. Ook zal de lezer worden aangemoedigd hier zijn eigen ervaringen mee te delen. Het is niet de bedoeling in deze rubriek onderzoeken uitvoerig te rapporteren. Daarvoor staan andere pagina's van de Acta Neuropsychiatrica voor u open.