benztropine and Depressive-Disorder

Prominent and persistent anxiety, depression, and/or negative features characterize a substantial minority of recovered or residually psychotic schizophrenic outpatients and contribute to poor outcome. Because extrapyramidal side effects of typical neuroleptic medications often resemble such features, we first systematically studied the contribution of extrapyramidal side effects to these problems and their treatment. For patients who remained distressed, controlled trials of supplemental thymoleptics were undertaken.. In trial 1, 92 distressed (depressed and/or anxious) patients and 36 patients in a defect state (patients with negative symptoms) participated in a double-blind, intramuscular challenge that compared centrally acting benztropine mesylate with peripherally acting glycopyrrolate. In trial 2, 57 distressed patients and 22 patients in a defect state were randomly assigned to a double-blind, neuroleptic medication dose-reduction group. In trial 3, 57 chronically distressed patients who were maintained on a low dose of fluphenazine decanoate were randomly assigned to a supplemental desipramine hydrochloride, lithium carbonate, or placebo group under double-blind conditions for 12 weeks.. For patients who were already maintained on antiparkinsonian medication, impaired affect was not resolved by additional benztropine. Only distressed patients with a family history of severe mental disorder (often affective) showed improvement with neuroleptic medication dose reduction. Patients in the defect-state group reported less dysphoria on a reduced neuroleptic medication dose, but negative symptoms persisted. Desipramine improved diverse aspects of mood and residual psychoticism, possibly as a prophylaxis against minor affective exacerbations. Depression improved in women only. Lithium positively affected multiple indexes of anxiety and anxious depression.. Most often, persistent affective impairments are neither resistant extrapyramidal side effects nor characterological traits. Thymoleptics improve the nonphasic, chronic types of anxiety and depression in contrast to the acute, episodic forms, for which little support can be found in the literature.

Topics: Adolescent; Adult; Ambulatory Care; Antipsychotic Agents; Anxiety Disorders; Basal Ganglia Diseases; Benztropine; Depressive Disorder; Desipramine; Diagnosis, Differential; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Fluphenazine; Glycopyrrolate; Humans; Lithium Carbonate; Male; Middle Aged; Placebos; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Sex Factors

Although recent studies have documented the benefit of adjunctive antidepressant medication for the short-term treatment of certain patients with operationally defined syndromes of postpsychotic depression, the value of maintenance adjunctive antidepressant treatment in this circumstance has not been properly established.. This study examined 24 schizophrenic or schizoaffective patients with postpsychotic depression or negative symptoms. These patients had all been benefited over the short term by the addition of adjunctive imipramine hydrochloride to their ongoing fluphenazine decanoate/benztropine mesylate regimens, and this adjunctive treatment had been successfully continued for 6 months. In a randomized double-blind protocol, treatment with adjunctive imipramine hydrochloride (mean, 233 +/- 72 mg/d) was then either maintained or tapered to placebo for an ensuing 1-year trial, while treatment with fluphenazine and benztropine continued.. Significantly more patients who received placebo substitution relapsed into depression (P < .001). Patients who received placebo substitution were also more likely to experience relapses into psychosis (P < .02).. These results support the clinical value of maintenance adjunctive imipramine therapy among initially responsive patients with postpsychotic depressions.

Topics: Adult; Antipsychotic Agents; Benztropine; Delayed-Action Preparations; Depressive Disorder; Double-Blind Method; Drug Therapy, Combination; Female; Fluphenazine; Humans; Imipramine; Male; Middle Aged; Placebos; Psychotic Disorders; Recurrence; Schizophrenia; Schizophrenic Psychology

Fifty-eight actively psychotic inpatients who initially met criteria for long-standing schizophrenia and subsequently met Research Diagnostic Criteria for a current episode of schizoaffective disorder (mainly schizophrenic) with a depressive syndrome, and who scored at least 30 (mean = 55, SEM = 1.6) on the Brief Psychiatric Rating Scale and 17 (mean = 23, SEM = 0.7) on the Hamilton Rating Scale for Depression, were treated for 5 weeks with haloperidol hydrochloride and benztropine. Haloperidol and benztropine treatment was continued, while those patients who consistently scored greater than 17 on the Hamilton Rating Scale for Depression were randomly assigned to the following double-blind treatment groups for 4 weeks: adjunctive amitriptyline hydrochloride, desipramine hydrochloride, or placebo. Adjunctive desipramine or amitriptyline showed no significant therapeutic advantage, when compared with haloperidol and placebo, on the Brief Psychiatric Rating Scale or the Hamilton Rating Scale for Depression. After 4 weeks of combine therapy, patients receiving adjunctive amitriptyline or desipramine, as compared with those receiving adjunctive placebo, tended to score higher on the Brief Psychiatric Rating Scale hallucinatory behavior item and on the thinking disturbance factor than patients receiving placebo. These results suggest that adjunctive antidepressants are not indicated for the treatment of depressive symptoms in actively psychotic schizophrenic inpatients. Adjunctive antidepressants may retard the rate of resolution of psychosis in this population.

Topics: Adolescent; Adult; Amitriptyline; Benztropine; Clinical Trials as Topic; Depressive Disorder; Desipramine; Double-Blind Method; Drug Therapy, Combination; Female; Haloperidol; Hospitalization; Humans; Male; Middle Aged; Placebos; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

The authors studied 46 patients with the operationally defined syndrome of postpsychotic depression following episodes of schizophrenia or schizoaffective disorder. Half of these patients were also found to satisfy criteria for negative symptoms. The patients with negative symptoms were rated as more severely ill on global measures, but there was only limited evidence that they were more depressed. Nevertheless, in a randomized double-blind trial of imipramine versus placebo as an adjunct to the fluphenazine decanoate and benztropine regimens of the patients with negative symptoms, the patients who received imipramine seemed to show more improvement.

Topics: Adolescent; Adult; Aged; Benztropine; Clinical Trials as Topic; Depressive Disorder; Double-Blind Method; Drug Therapy, Combination; Female; Fluphenazine; Humans; Imipramine; Male; Middle Aged; Psychiatric Status Rating Scales; Psychotic Disorders; Random Allocation; Schizophrenia; Schizophrenic Psychology

Patients receiving fluphenazine decanoate who were switched from adjunctive benztropine to imipramine in a double-blind trial experienced marked exacerbations of extrapyramidal side effects. No substantial increase in anticholinergic side effects occurred, however, when imipramine was added to fluphenazine decanoate and benztropine.

Topics: Adult; Benztropine; Clinical Trials as Topic; Depressive Disorder; Double-Blind Method; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Female; Fluphenazine; Humans; Imipramine; Male; Middle Aged; Tropanes

A broad range of neuropsychological function was compared in samples of young adult unipolar depressed inpatients with and without psychotic features. Consistent with expectations, the psychotic depressive group demonstrated a broad range of deficit and had more impaired performances than the nonpsychotic group. Relevance of these data for hypotheses concerning psychotic depression as a unique diagnostic entity is discussed. In the context of previous research, the current findings suggest that accounting for individual differences in depression may clarify discrepancies between earlier studies of neuropsychological function in depression, and our understanding of the mechanisms by which depression influences cognition may be refined.

Topics: Adult; Attention; Benztropine; Cognition Disorders; Depressive Disorder; Dopamine; Dopamine Uptake Inhibitors; Dose-Response Relationship, Drug; Female; Humans; Male; Memory Disorders; Neuropsychological Tests; Psychotic Disorders; Severity of Illness Index; Verbal Behavior; Verbal Learning

Topics: Benztropine; Cyclohexanols; Depressive Disorder; Female; Humans; Hyperhidrosis; Middle Aged; Selective Serotonin Reuptake Inhibitors; Sweating; Venlafaxine Hydrochloride

Topics: 1-Naphthylamine; Adult; Benztropine; Delirium; Depressive Disorder; Drug Interactions; Drug Therapy, Combination; Female; Haloperidol; Humans; Lithium; Parkinson Disease, Secondary; Selective Serotonin Reuptake Inhibitors; Sertraline

Depression is commonly associated with idiopathic Parkinson's disease. Various antidepressants can be helpful in the treatment of this type of depression. Anticholinergic medications are at times used for treating the motor symptoms of parkinsonism. While some authors have reported euphorigenic effects from anticholinergics in other groups of patients, generally, they have not been used in the treatment of depression, with or without parkinsonism. In the case presented, a depressed patient with Parkinson's disease on levodopa/carbidopa and fluoxetine was given benztropine for his motor symptoms. The result was some improvement in his motor symptoms and a wide, dose-related spectrum of other central nervous system changes ranging from delirium to mania, hypomania, and euthymia from a "baseline" of residual depression. At a very low dose (0.25 mg per day), benztropine appeared to have an augmenting antidepressant effect that rendered the patient euthymic.

Topics: Aged; Benztropine; Carbidopa; Depressive Disorder; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fluoxetine; Humans; Levodopa; Male; Parkinson Disease; Treatment Outcome

Depression is commonly associated with the longitudinal course of schizophrenia. Several etiologies for this problem have been proposed but, to our knowledge, noncompliance with antiparkinsonian medications has not been considered.. Case histories of two patients who were noncompliant and one who threatened noncompliance with antiparkinsonian medications are presented. All three patients were diagnosed with schizophrenia by DSM-III-R criteria and had been clinically stable for long periods.. All three patients became depressed when their adjunctive benztropine was stopped, and their depressions remitted when their benztropine was reinstated.. Noncompliance with antiparkinsonian medications may be associated with a reversible depression in patients receiving maintenance neuroleptics for schizophrenia. Since this is a newly described phenomenon, the scope of the problem is not known; however, it may contribute to the wide prevalence of depressive symptoms in schizophrenia. Clinical measures to facilitate detection of such noncompliance are discussed.

Topics: Adult; Antiparkinson Agents; Antipsychotic Agents; Basal Ganglia Diseases; Benztropine; Depressive Disorder; Dyskinesia, Drug-Induced; Female; Humans; Male; Parkinson Disease, Secondary; Schizophrenia; Treatment Refusal

Identification of symptoms that are directly responsive to neuroleptic drugs at progressive phases of treatment is important for monitoring drug response and understanding the relationship between neurochemical mechanisms of drug action and disordered behavior. Using multiple regression analyses that controlled for pretreatment severity, we identified those symptoms that improved in direct relation to serum concentrations of perphenazine after 10 days of treatment. Improvement in two positive symptoms of psychosis--hallucinations and conceptual disorganization--appears to be related to perphenazine level and useful for assessment of early drug response.

Topics: Adult; Benztropine; Bipolar Disorder; Depressive Disorder; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Haloperidol; Humans; Male; Perphenazine; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology

Ten patients with histories of postpsychotic depression responsive to adjunctive imipramine added to fluphenazine decanoate and benztropine underwent a double-blind trial of imipramine discontinuation 6 months after responding to the adjunctive imipramine. Discontinuation of imipramine was associated with depressive relapse.

Topics: Adult; Benztropine; Depressive Disorder; Double-Blind Method; Drug Therapy, Combination; Fluphenazine; Humans; Imipramine; Middle Aged; Psychotic Disorders; Tranquilizing Agents

Four of five patients who had had an operationally defined syndrome of postpsychotic depression, which had been responsive to adjunctive imipramine added to an ongoing regimen of fluphenazine decanoate and benztropine, suffered a return of depressive symptomatology following the tapering of the adjunctive imipramine 6 months after the initial response to imipramine therapy. Four comparison patients who were not tapered experienced no such reexacerbations (p = .04). The authors discuss implications of this finding for maintenance adjunctive antidepressant treatment strategies.

Topics: Benztropine; Depressive Disorder; Drug Therapy, Combination; Fluphenazine; Humans; Imipramine; Psychotic Disorders; Recurrence; Schizophrenia; Substance Withdrawal Syndrome

Topics: Adult; Akathisia, Drug-Induced; Amoxapine; Benztropine; Depressive Disorder; Dibenzoxazepines; Dyskinesia, Drug-Induced; Humans; Male; Psychomotor Agitation

Topics: Aged; Benztropine; Depressive Disorder; Humans; Male; Parasympatholytics; Physostigmine; Syndrome; Thiothixene; Urination Disorders