The TRH-test in depression: a review

This paper reviews the literature on the thyrotropin releasing hormone (TRH)-test in depressive patients. The TRH-test appears to exhibit some use as an external validating criterion for the clinical diagnosis of major depression and, in particular melancholia versus minor depression once the clinical diagnosis depression is made. However, the clinical use of this test is hampered by the low sensitivity (±50%) and by the fact that abnormal tests occur in non-depressive states such as borderline personality disorder, schizophrenia, and anxiety disorders. The TRH-test may be used as a predictor for a positive response to biological therapies. In addition, the test has some value for the outcome of a depressive episode. The pathophysiology underpinning an abnormal TRH-test may be determined by noradrenergic (central and peripheric) or serotonergic (central) dysfunctions, thyroid hormone and cortisol hypersecretion, phenomena that are pertinent to severe depression. Recently, it has been established that an abnormal depression-linked TRH-test reflects lower basal thyroid secreting hormone (TSH) secretion. The determination of basal TSH may, in the future, replace TRH-testing.

After a description of the harmful effects of psychotropic drugs as well as of the moments of vulnerability to any teratogenic effect, this paper reviews prospective, retrospective and epidemiological studies of the teratogenic effects of anticonvulsants (phenytoin, valproic acid, carbamazepine and barbiturates), lithium, anti-psychotics, benzodiazepines and anti-depressive agents. It is found that the results of these studies are not unequivocal. Only lithium and valproic acid are shown to be teratogenic. In cases where malformations of the fetus are observed, the treatment often consisted in a combination of various psychotropic drugs.

The review is completed with data on the psychopharmacological problems during delivery and their side-effects on the newborn.

Interrater reliability of the Hamilton Rating Scale for Depression

Interrater reliability of the Dutch version of the Hamilton Rating Scale for Depression (HRSD 17 items) was investigated. Although sufficient, a kappa of .65, found for all raters, was not very high. Specifically item 2 (feelings of guilt) and item 11 (psychic anxiety) seemed difficult to judge. The most experienced raters achieved the highest kappas as well on the total score of the HRSD.

It is concluded that this version of the HRSD, if administered by experienced raters, is a reasonably reliable instrument to obtain a certain ‘cut-off score (for instance in-exclusion criterium) as well as to measure the change in severity of the depression during treatment.

Neuroleptics: preclinical and clinical differences

In this review we propose that the clinical and preclinical effects of neuroleptic drugs justify a distinction between classical and atypical neuroleptic drugs. Binding, biochemical, electrophysiological and behavioural studies have revealed clearcut differences between classical neuroleptics (like haloperidol and fluphenazine) and atypical neuroleptics (such as clozapine, thioridazine and remoxipride). These large differences are likely due to differences in the workingmechanisms. In view of the clinical relevance of these findings it is therefore both justified and essential to subdivide the neuroleptics in two distinct groups: the classical neuroleptics and the atypical neuroleptics.