Editorial: Hypertension and depression and their treatment

Free-running circadian activity rhythms during long-term clonidine administration in rats

Experimental and clinical studies indicate that the alpha-adrenergic agonist clonidine can alter mood and activity. However, the behavioral effects of this agent are complex and appear to depend on duration of treatment. Recent work from this laboratory demonstrated that clonidine systematically alters the period, amplitude, and level of free-running circadian activity rhythms in rats. The present study confirms and extends previous observations by employing a longer duration of clonidine treatment. The results show that chronic clonidine administration reversibly shortens the free-running period and reduces the amplitude of the free-running rhythm in constant light. Furthermore, clonidine treatment can increase or decrease the level of activity, depending on baseline activity level, and these effects are not consistently reversed following the termination of treatment. These observations support the hypothesis that noradrenergic systems influence both the circadian periodicity and the level of spontaneous activity, and that clonidine may influence these two parameters by acting at different neural or neuronal loci.

A placebo-controlled crossover study of oral clonidine in acute anorexia nervosa

The alpha 2-adrenergic agonist clonidine has been reported to increase feeding in several species. This study evaluated the effects of clonidine (500-700 micrograms/day), administered per os, to four treatment-resistant anorexia nervosa patients in a long-term placebo-controlled crossover trial. All patients increased their body weight significantly. Clonidine administration, however, did not influence the rate of weight gain, nor did clonidine affect hunger or satiety sensations. Similarly, 24-hour urinary 3-methoxy-4-hydroxyphenylglycol levels and levels of anxiety and depression were unchanged by clonidine. By contrast, clonidine showed significant hemodynamic effects; clonidine lowered systolic and diastolic blood pressure, reduced pulse rate, and produced sedation. Discontinuation of clonidine was associated with a small but significant weight loss compared to a small weight increase during the initiation of clonidine treatment. The results suggest that clonidine may not be indicated in the treatment of anorexia nervosa.

Validation of a decision model for triaging hypertensive patients to alternate health education interventions

The ability to assign patients to the most appropriate program of intervention would improve patient outcomes and reduce health care costs. This paper evaluates specific potentials of triaging patients into various combinations of health education treatments. Blood pressure improvement among hypertensive patients was measured and the associated treatment cost and savings were compared. Triaging rules were formed empirically from the relationship between patient characteristics selected before the study was conducted and their achieved blood pressure control within each combination of interventions. Patients randomly assigned to seven combinations of three interventions were studied in contrast to patients in a randomized control group. A combination of all three interventions was the most effective program for the undifferentiated (random) patient population, achieving a 49% increase over 18 months in patients with blood pressure under control. By triaging, 51-91% increases in patients with controlled blood pressure were achieved. Educational history of the patients which is a fairly reliable measure was the most efficient triaging variable, showing a 91% increase in patients with blood pressure under control and a relative cost saving of about 400%.

Psychotropic drugs in somatic disorders

Current trends in the employment of psychotropic medication in somatic illness are considered, and some of the theoretical issues raised by this practice are explored. While much further clinical investigation is needed, a review is made of currently available knowledge regarding psychopharmacotherapy in specific clinical settings: pain, delirium, ischemic heart disease, gastrointestinal disorders, dermatological illness, and in renal, hepatic and pulmonary insufficiency.