Re: depression and adverse cardiovascular events

[Guest guest]

Francis, I'll throw this out but will leave the interpretation to Dr. Bolton or

others here if they understand it! (Again, small sample and looks like it was

limited to men and a very high dose of Spiro if I read it right.)

Neuropsychopharmacology. 2007 Jan;32(1):232-8. Epub 2006 Oct 11.

Blockade of the mineralocorticoid receptor in healthy men: effects on

experimentally induced panic symptoms, stress hormones, and cognition.

Otte C, Moritz S, Yassouridis A, Koop M, Madrischewski AM, Wiedemann K, Kellner

M.

SourceDepartment of Psychiatry and Psychotherapy, University Hospital

Hamburg-Eppendorf, Hamburg, Germany. otte@...

Abstract

Animal studies have shown that blockade of central mineralocorticoid receptors

(MR) has anxiolytic effects and impairs several aspects of cognitive function.

No study to date assessed the effects of MR blockade on anxiety and cognitive

function in humans. In the present study, 16 healthy young men were treated

either with placebo or with 300 mg spironolactone, a MR-antagonist, at 1100,

1330, and 1630 hours in a balanced cross-over design with the two study

conditions being 1 week apart. At 1500 hours, the panic symptoms provoking

compound cholecystokinin-tetrapeptide (CCK-4) was administered i.v. on both

occasions and panic symptoms were assessed. We measured plasma ACTH and cortisol

between 1300 and 1900 hours and assessed cognitive function between 1800 and

1900 hours. CCK-4 elicited panic symptoms and increased ACTH and cortisol

secretion in both conditions. Intensity of panic symptoms after CCK-4 was not

different between spironolactone and placebo. Spironolactone significantly

impaired selective attention and delayed recall of visuospatial memory, and

diminished set shifting/mental flexibility on a trend level. Pretreatment with

spironolactone led to higher baseline cortisol levels compared to placebo

whereas no differences in stimulated cortisol, baseline ACTH, and stimulated

ACTH emerged. Blockade of MR with spironolactone increases baseline cortisol

secretion and impairs cognitive function but has no effect on experimentally

induced panic symptoms in humans, for the study design and dosage of

spironolactone used. The domains of cognitive function that are impaired after

blockade of MR in men, that is, selective attention, visuospatial memory, and

mental flexibility/set shifting appear to be remarkably similar to those

described in animal studies.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2.

and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

Metformin 2000MG and Spironolactone 75 MG.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Titre du document / Document title

> > > > > > > > > > > > > > Increased plasma aldosterone in patients with

> > > > clinical

> > > > > > > > > > > depression

> > > > > > > > > > > > > > Auteur(s) / Author(s)

> > > > > > > > > > > > > > EMANUELE Enzo ; GEROLDI Diego ; MINORETTI

> > > > Piercarlo ; COEN

> > > > > > > > > > > Enrico ; POLITI Pierluigi ;

> > > > > > > > > > > > > > RÃÆ'©sumÃÆ'© / Abstract

> > > > > > > > > > > > > > Background. Clinical depression has been

> > > > increasingly

> > > > > > > > > > > recognized as an independent risk factor for adverse

> > > > cardiovascular

> > > > > > > > > > > events, but the biological mechanisms of this

> > > > association remain

> > > > > > > > > > > unclear. Recent evidence for reninsystem

> > dysregulation

> > > > in patients

> > > > > > > > > > > with depression led us to hypothesize that

> > aldosterone-

> > > > a well-

> > > > > > > > > > > recognized contributor to vascular injury-could be

> > > > increased in

> > > > > > > > > > > depressed patients. The present study was designed,

> > > > therefore, to be

> > > > > > > > > > > a cross-sectional investigation of plasma renin and

> > > > aldosterone

> > > > > > > > > > > levels in depressed patients as compared with

> > healthy

> > > > controls with

> > > > > > > > > > > no history of psychiatric illness. Methods. A

> > total of

> > > > 65 depressed

> > > > > > > > > > > patients and 65 age- and gender-matched control

> > > > subjects were

> > > > > > > > > > > enrolled. Following a fixed sodium and potassium

> > diet,

> > > > venous blood

> > > > > > > > > > > samples were obtained at 9:00 a.m. to avoid the

> > > > influence of

> > > > > > > > > > > circadian rhythms. Results. Although there were no

> > > > significant

> > > > > > > > > > > differences in plasma level of renin among subjects

> > > > with depression

> > > > > > > > > > > and controls (7.9 & #8242; 5.8 vs. 6.4 & #8242; 4.3

> > pg/mL,

> > > > > > > > > > > respectively; p = 0.10), depressed subjects

> > exhibited

> > > > greater mean

> > > > > > > > > > > aldosterone levels as compared with control subjects

> > > > (157.2 & #8242;

> > > > > > > > > > > 67.5 vs. 125.7 & #8242; 38.1 pg/mL, respectively; p =

> > > > 0.0014). After

> > > > > > > > > > > adjusting for potential confounders, multivariate

> > > > logistic

> > > > > > > > > > > regression analysis showed that subjects with

> > > > depression had 2.77

> > > > > > > > > > > times higher odds of elevated aldosterone levels

> > > > compared with

> > > > > > > > > > > healthy control subjects (95% confidence interval,

> > > > 1.30-5.92, p =

> > > > > > > > > > > 0.008). Conclusions. Our present findings support

> > the

> > > > hypothesis

> > > > > > > > > > > that hyperaldosteronism could be a common feature

> > > > among depressed

> > > > > > > > > > > patients, thereby suggesting that increased

> > > > aldosterone levels may

> > > > > > > > > > > act as a mediator in the pathway linking

> > depression to

> > > > unfavorable

> > > > > > > > > > > vascular events.

> > > > > > > > > > > > > > Revue / Journal Title

> > > > > > > > > > > > > > Archives of medical research ISSN 0188-4409

> > > > > > > > > > > > > > Source / Source

> > > > > > > > > > > > > > 2005, vol. 36, no5, pp. 544-548 [5 page(s)

> > > > (article)]

> > > > > > > > > > > > > > Langue / Language

> > > > > > > > > > > > > > Anglais

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Editeur / Publisher

> > > > > > > > > > > > > > Elsevier, New York, NY, ETATS-UNIS (1992)

> > (Revue)

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Localisation / Location

> > > > > > > > > > > > > > INIST-CNRS, Cote INIST : 18673,

> > > > 35400013278933.0200

> > > > > > > > > > > > > >

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Nº notice refdoc (ud4) : 17228709

> > > > > > > > > > > > > >

> > > > > > > > > > > > >

> > > > > > > > > > > > >

> > > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

If the dose is correct it was huge 900 Mg Spiro in one day. Guess I have be too timid. Tiped nsad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Francis, I'll throw this out but will leave the interpretation to Dr. Bolton or others here if they understand it! (Again, small sample and looks like it was limited to men and a very high dose of Spiro if I read it right.)

Neuropsychopharmacology. 2007 Jan;32(1):232-8. Epub 2006 Oct 11.

Blockade of the mineralocorticoid receptor in healthy men: effects on experimentally induced panic symptoms, stress hormones, and cognition.

Otte C, Moritz S, Yassouridis A, Koop M, Madrischewski AM, Wiedemann K, Kellner M.

SourceDepartment of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. otte@...

Abstract

Animal studies have shown that blockade of central mineralocorticoid receptors (MR) has anxiolytic effects and impairs several aspects of cognitive function. No study to date assessed the effects of MR blockade on anxiety and cognitive function in humans. In the present study, 16 healthy young men were treated either with placebo or with 300 mg spironolactone, a MR-antagonist, at 1100, 1330, and 1630 hours in a balanced cross-over design with the two study conditions being 1 week apart. At 1500 hours, the panic symptoms provoking compound cholecystokinin-tetrapeptide (CCK-4) was administered i.v. on both occasions and panic symptoms were assessed. We measured plasma ACTH and cortisol between 1300 and 1900 hours and assessed cognitive function between 1800 and 1900 hours. CCK-4 elicited panic symptoms and increased ACTH and cortisol secretion in both conditions. Intensity of panic symptoms after CCK-4 was not different between spironolactone and placebo. Spironolactone significantly impaired selective attention and delayed recall of visuospatial memory, and diminished set shifting/mental flexibility on a trend level. Pretreatment with spironolactone led to higher baseline cortisol levels compared to placebo whereas no differences in stimulated cortisol, baseline ACTH, and stimulated ACTH emerged. Blockade of MR with spironolactone increases baseline cortisol secretion and impairs cognitive function but has no effect on experimentally induced panic symptoms in humans, for the study design and dosage of spironolactone used. The domains of cognitive function that are impaired after blockade of MR in men, that is, selective attention, visuospatial memory, and mental flexibility/set shifting appear to be remarkably similar to those described in animal studies.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > > > > > > > > >

> > > > > >

[Guest guest]

this is a link to full text of this.

http://www.nature.com/npp/journal/v32/n1/full/1301217a.html

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