Nortriptyline - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

NORTRIPTYLINE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Nortriptyline: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84531-X 1. Nortriptyline-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on nortriptyline. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON NORTRIPTYLINE ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Nortriptyline................................................................................. 5 The National Library of Medicine: PubMed ................................................................................ 22 CHAPTER 2. NUTRITION AND NORTRIPTYLINE .............................................................................. 67 Overview...................................................................................................................................... 67 Finding Nutrition Studies on Nortriptyline................................................................................ 67 Federal Resources on Nutrition ................................................................................................... 68 Additional Web Resources ........................................................................................................... 69 CHAPTER 3. CLINICAL TRIALS AND NORTRIPTYLINE .................................................................... 71 Overview...................................................................................................................................... 71 Recent Trials on Nortriptyline..................................................................................................... 71 Keeping Current on Clinical Trials ............................................................................................. 72 CHAPTER 4. PERIODICALS AND NEWS ON NORTRIPTYLINE .......................................................... 75 Overview...................................................................................................................................... 75 News Services and Press Releases................................................................................................ 75 Academic Periodicals covering Nortriptyline .............................................................................. 77 CHAPTER 5. RESEARCHING MEDICATIONS .................................................................................... 79 Overview...................................................................................................................................... 79 U.S. Pharmacopeia....................................................................................................................... 79 Commercial Databases ................................................................................................................. 80 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 83 Overview...................................................................................................................................... 83 NIH Guidelines............................................................................................................................ 83 NIH Databases............................................................................................................................. 85 Other Commercial Databases....................................................................................................... 87 APPENDIX B. PATIENT RESOURCES ................................................................................................. 89 Overview...................................................................................................................................... 89 Patient Guideline Sources............................................................................................................ 89 Finding Associations.................................................................................................................... 95 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 97 Overview...................................................................................................................................... 97 Preparation................................................................................................................................... 97 Finding a Local Medical Library.................................................................................................. 97 Medical Libraries in the U.S. and Canada ................................................................................... 97 ONLINE GLOSSARIES................................................................................................................ 103 Online Dictionary Directories ................................................................................................... 103 NORTRIPTYLINE DICTIONARY ............................................................................................. 105 INDEX .............................................................................................................................................. 147

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with nortriptyline is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about nortriptyline, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to nortriptyline, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on nortriptyline. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to nortriptyline, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on nortriptyline. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON NORTRIPTYLINE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on nortriptyline.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and nortriptyline, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “nortriptyline” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Changes in Cognitive Functioning Following Treatment of Late-Life Depression Source: American Journal of Psychiatry. 157(12): 1949-1954. December 2000. Summary: This article examines the cognitive effects of treatment for depression in older patients. The sample consisted of 62 elderly patients with major depression, and 20 elderly controls were studied. Although some patients exhibited cognitive impairment at baseline, none met the diagnostic criteria for dementia. Of the 60 patients, 45 achieved remission of depressive symptoms after 12 weeks of treatment with the tricyclic agent nortriptyline or the selective serotonin reuptake inhibitor paroxetine. All participants completed a battery of clinical measures, including cognitive screening instruments, before and after treatment. Depressed patients with normal cognition at baseline showed no change in cognitive function after treatment, whereas those with cognitive impairment at baseline showed significant improvement in the domains of

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initiation/perseveration and conceptualization. Despite this improvement, however, patients with baseline cognitive impairment remained mildly impaired, especially in the memory and initiation/perseveration domains. This subgroup of elderly depressed patients may be at higher risk of developing progressive dementia. 3 tables, 29 references. •

Pharmacological Treatment of Painful Diabetic Neuropathy Source: Clinical Diabetes. 18(3): 116-118. 2000. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reviews studies on the effectiveness of various drugs in managing diabetic neuropathy. Control of pain is a major goal for most patients and their physicians in managing diabetic neuropathy. Studies have demonstrated the effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and sulindac; tricyclic antidepressants such as amitriptyline, imipramine, nortriptyline, and desipramine; serotonin reuptake inhibitors such as paroxetine and fluoxetine; and anticonvulsants such as gabapentin and carbamazepine. Although NSAIDs can offer pain relief, especially in patients with musculoskeletal or joint abnormalities secondary to long term neuropathy, the tricyclic antidepressants remain the most commonly used drugs in the treatment of painful neuropathy. In addition, several other oral agents including the anti-arrythmic agent mexiletine, tramadol, and topical capsaicin cream have been found to be effective in relieving pain associated with diabetic neuropathy. Other nonsystemic pain control treatments that have been studied include transcutaneous electrical nerve stimulation units and acupuncture. 28 references.

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Behavioral Assessment of the Effects of Psychotropic Medications on Demented Nursing Home Residents Source: Behavior Modification. 15(2): 194-212. April 1991. Summary: This journal article reports on a study to examine the effects of different psychotropic medication for controlling behavioral problems associated with dementia in three elderly residents of nursing homes. The goal of the study was to assess the drugs' specific effects on aberrant and adaptive behaviors, motor performance, and somnolence. The results suggested that the medications prescribed, including the neuroleptics thiothixene, thioridazine, and haloperidol as well as an antidepressant, nortriptyline, were effective in decreasing the occurrence of aberrant behaviors in the three elderly residents. The aberrant behaviors included both disruptive behaviors and delusional verbalizations. The only behavior that was not affected by the introduction of a psychotropic medication was somatic complaints. The authors note that conclusions regarding the efficacy of the study medications must be interpreted with caution because of the small sample size and the lack of complete reversal during phases when the medications were withdrawn. 20 references.

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Eating Disorders and Diabetes: Diagnosis and Management Source: Diabetes Spectrum. 3(6): 361-397. November-December 1990. Summary: This special section of Diabetes Spectrum addresses current research on the epidemiology, assessment, and treatment of eating disorders in general and findings related specifically to eating disorders among people with IDDM. Two research articles report on a research study of abnormal eating attitudes in young people with IDDM and

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a comparison study of antidepressants and structured intensive group psychotherapy in treatment of bulimia nervosa. The ten research summaries cover relevant topics, including the prevalence of bulimia nervosa in the U.S. college student population; the development and validation of a multidimensional eating disorder inventory for anorexia and bulimia; a comparison of the psychological treatments, including family therapy, for bulimia nervosa and anorexia nervosa; imipramine in the treatment of bulimia; eating disorders in female adolescents with IDDM; and nortriptyline and atenolol for the treatment of bulimia in women with diabetes. Each article includes references.

Federally Funded Research on Nortriptyline The U.S. Government supports a variety of research studies relating to nortriptyline. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to nortriptyline. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore nortriptyline. The following is typical of the type of information found when searching the CRISP database for nortriptyline: •

Project Title: AFFECT, DEPRESSION AND BRAIN ASYMMETRY Principal Investigator & Institution: Davidson, Richard J.; Vilas Professor; Psychology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001; Project Start 30-SEP-1997; Project End 30-APR-2004 Summary: (Adapted from applicant's abstract): The proposed research will replicate and extend our studies of cerebral asymmetry and depression. In the prior grant period, the investigator used PET measures of regional cerebral glucose metabolism, along with simultaneously recorded brain electrical activity (EEG) to examine patterns of conical and subcortical activity in melancholic and nonmelancholic depressives when they were acutely depressed and then after a course of treatment with nortriptyline. The research conducted during the prior phase was restricted to examining relations between measures of regional brain function and self-report or interview-based indices of symptomatology and emotion. The investigators findings indicated that PET and EEG measures of prefrontal activation asymmetry were significantly correlated and predicted depressive symptomatology. The analysis of the EEG data to date indicate robust differences between melancholic and nonmelancholic subtypes, with the former characterized by decreased left prefrontal activation, while the latter was characterized by increased right prefrontal activation. The PET measures further revealed a circuit that

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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included the amygdala, hypothalamus, parietal cortex, along with medial prefrontal regions that distinguished between depressed and control subjects. Moreover, metabolic activity in these regions predicted the magnitude of response to antidepressant medication. The indices of cortical metabolism changed with treatment but amygdala metabolism did not. In the next phase of this research program, the investigator will address a number of questions that have emerged from the previous phase. He will examine the relation between EEG and PET measures of regional brain function and experimental measures of reactivity to and recovery from standardized positive and negative affective stimuli. These studies will utilize emotion-modulated startle and classical conditioning to make inferences about emotional reactivity and recovery. These methods provide important clues to the mechanisms which underlie affective differences among the investigator's groups. These measures will be obtained on four separate occasions. First during an acute episode when all patients are off medication. Second, patients will then be treated with paroxetine and will be retested after meeting criteria for recovery. Patients will be maintained on paroxetine for 12 months following recovery. A third testing session will be held 6 months after the second. The fourth testing session will be held when patients have had a recurrence or after 12 months have elapsed. During each assessment period, subjects will undergo an FDG-PET scan, and will be administered the emotion-modulated startle and conditioning protocols. This design will permit the investigator to separate the effects of medication versus symptom change in examining within subjects change in brain function and behavior. It will also enable him to rigorously examine those patterns of brain function that predict treatment response and recurrence and to identify the patterns of brain function associated with group differences in emotional reactivity and recovery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION

COGNITIVE

THERAPY

AND

PHARMACOTHERAPY

FOR

Principal Investigator & Institution: Hollon, Steven D.; Professor; Psychology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-MAY-2000; Project End 30-APR-2005 Summary: (Adapted from the Applicant's Abstract): This is a request for five years of salary support via a NIH Independent Scientist Award (K02). I have long sought to integrate psychosocial and biological models of depression, and I hope to use the RCA to enhance my understanding of basic neurobiology and developmental issues relevant to its nature and treatment. I also want to enhance the relevance of my work to applied clinical settings (effectiveness). In particular, I am interested in whether cognitive therapy has a more enduring effect than drugs in the treatment of depression. Earlier studies suggested that this might be the case, but the recent NIH TDCRP found cognitive therapy to be less effective than drugs in the treatment of more severely depressed outpatients and reported little evidence of any enduring effect. Both sets of studies have been criticized for failing to provide optimal implementations of the respective modalities, drugs in the earlier studies and cognitive therapy in the TDCRP. We are currently conducting (with colleagues at Penn) a placebo-controlled comparison of cognitive therapy versus drugs in the treatment of more severely depressed outpatients that seek to address both sets of concerns. I am also collaborating with Neil Jacobson in Seattle in a similar placebo-controlled trial designed to determine whether behavioral activation (which is simpler to implement) carries the full weight of change in cognitive therapy. Further, we plan to examine (with colleagues at Penn and Rush) whether adding cognitive therapy to drugs can both enhance the breadth of response

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and obviate the need to keep patients on long-term maintenance medications. Finally, we are collaborating with colleagues at each of these sites to study the impact of treatment on the offspring of our depressed patients. We think that more can be done to study the full range of benefits associated with successful treatment. My goal has been to examine the role of both psychological and biological processes in the moderation and medication of treatment effects and to do so in a manner that has the greatest possible impact on actual clinical practice. I hope to use my growing expertise in neurobiology and development to better understand the processes that underlie the treatment and prevention of depression and to use that understanding to enhance the effectiveness of clinical practice in applied settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTINUATION ECT VERSUS PHARMACOTHERAPY Principal Investigator & Institution: Husain, Mustafa M.; Associate Professor; Psychiatry; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-FEB-1997; Project End 30-APR-2004 Summary: (Provided by Applicant): This is a competing renewal application seeking two years of additional funding to complete the ongoing multi-site study, "Continuation ECT: Efficacy and Safety." The goal of this research is to compare continuation ECT with an aggressive combination pharmacotherapy strategy (nortriptyline plus lithium) in the prevention of depressive relapse after successful ECT for major depression. As of May 30, 2001, we have successfully enrolled 470 patients into the acute ECT phase of the study (Phase I) and 159 patients into the two treatment arm randomized phase (Phase II). This represents 73 percent of the necessary recruitment target. An additional 56 randomized patients will be enrolled to meet the target randomized sample size of 216. Completion of patient recruitment, follow-up, and analysis of results can be accomplished with the additional 24 months requested in this application. Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive disorder (MDD). Relapse after acute phase ECT or pharmacotherapy remains a major public health problem. Recent studies show an alarmingly high rate of relapse after ECT despite conventional pharmacotherapy (C-PHARM). Continuation ECT (C-ECT) is also in widespread clinical use, however, its efficacy and safety have never been rigorously tested. The role of C-ECT in relapse prevention of seriously ill patients with MDD urgently needs to be defined. The ongoing study is a prospective, six-month, randomized clinical trial in which patients with MDD who remit with an acute course of bilateral ECT are randomized to one of two treatment arms: C-PHARM (nortriptyline + lithium) or C-ECT. The major hypothesis is that C-ECT will more effectively prevent relapse than C-PHARM. The two continuation therapies also will be compared in their effects on cognitive performance, global functioning, side effects, and perceived health status. Study design features include rigorous remitter criteria, blinded neuropsychological assessments, rigorous quality control procedures including independent, blind rating of videotaped Hamilton Depression Rating Scale and SCID interviews, and independent oversight of data collection and analysis. When completed, this project will provide the first and definitive data on the role of C-ECT in the treatment of serious affective illness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CONTINUATION ECT VS PHARMACOTHERAPY: EFFICACY & SAFETY Principal Investigator & Institution: Rummans, Teresa A.; Associate Professor of Psychiatry; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-FEB-1997; Project End 30-APR-2004 Summary: (Provided by Applicant): This is a competing renewal application seeking two years of additional funding to complete the ongoing multi-site study, "Continuation ECT versus Pharmacotherapy." The goal of this research is to compare continuation ECT with an aggressive combination pharmacotherapy strategy (nortriptyline plus lithium) in the prevention of depressive relapse after successful ECT for major depression. As of May 30, 2001, we have successfully enrolled 470 patients into the acute ECT phase of the study (Phase I) and 159 patients into the two treatment arm randomized phase (Phase II). This represents 73 percent of the necessary recruitment target. An additional 56 randomized patients will be enrolled to meet the target randomized sample size of 216. Completion of patient recruitment, follow-up, and analysis of results can be accomplished with the additional 24 months requested in this application. Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive disorder (MDD). Relapse after acute phase ECT or pharmacotherapy remains a major public health problem. Recent studies show an alarmingly high rate of relapse after ECT despite conventional pharmacotherapy (C-PHARM). Continuation ECT (C-ECT) is also in widespread clinical use, however, its efficacy and safety have never been rigorously tested. The role of C-ECT in relapse prevention of seriously ill patients with MDD urgently needs to be defined. The ongoing study is a prospective, six-month, randomized clinical trial in which patients with MDD who remit with an acute course of bilateral ECT are randomized to one of two treatment arms: C-PHARM (nortriptyline + lithium) or C-ECT. The major hypothesis is that C-ECT will more effectively prevent relapse than C-PHARM. The two continuation therapies also will be compared in their effects on cognitive performance, global functioning, side effects, and perceived health status. Study design features include rigorous remitter criteria, blinded neuropsychological assessments, rigorous quality control procedures including independent, blind rating of videotaped Hamilton Depression Rating Scale and SCID interviews, and independent oversight of data collection and analysis. When completed, this project will provide the first and definitive data on the role of C-ECT in the treatment of serious affective illness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CONTINUATION ECT VS PHARMACOTHERAPY: EFFICACY AND SAFETY Principal Investigator & Institution: Kellner, Charles H.; Professor and Chairman; Psychiatry; Univ of Med/Dent Nj Newark Newark, Nj 07103 Timing: Fiscal Year 2002; Project Start 01-FEB-1997; Project End 30-APR-2004 Summary: (Provided by Applicant): This is a competing renewal application seeking two years of additional funding to complete the ongoing multi-site study, "Continuation ECT versus Pharmacotherapy." The goal of this research is to compare continuation ECT with an aggressive combination pharmacotherapy strategy (nortriptyline plus lithium) in the prevention of depressive relapse after successful ECT for major depression. As of May 30, 2001, we have successfully enrolled 470 patients into the acute ECT phase of the study (Phase I) and 159 patients into the two treatment arm randomized phase (Phase II). This represents 73 percent of the necessary recruitment target. An additional 56

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randomized patients will be enrolled to meet the target randomized sample size of 216. Completion of patient recruitment, follow-up, and analysis of results can be accomplished with the additional 24 months requested in this application. Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive disorder (MDD). Relapse after acute phase ECT or pharmacotherapy remains a major public health problem. Recent studies show an alarmingly high rate of relapse after ECT despite conventional pharmacotherapy (C-PHARM). Continuation ECT (C-ECT) is also in widespread clinical use, however, its efficacy and safety have never been rigorously tested. The role of C-ECT in relapse prevention of seriously ill patients with MDD urgently needs to be defined. The ongoing study is a prospective, six-month, randomized clinical trial in which patients with MDD who remit with an acute course of bilateral ECT are randomized to one of two treatment arms: C-PHARM (nortriptyline + lithium) or C-ECT. The major hypothesis is that C-ECT will more effectively prevent relapse than C-PHARM. The two continuation therapies also will be compared in their effects on cognitive performance, global functioning, side effects, and perceived health status. Study design features include rigorous remitter criteria, blinded neuropsychological assessments, rigorous quality control procedures including independent, blind rating of videotaped Hamilton Depression Rating Scale and SCID interviews, and independent oversight of data collection and analysis. When completed, this project will provide the first and definitive data on the role of C-ECT in the treatment of serious affective illness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTINUATION ECT VS PHARMACOTHERAPY--EFFICACY AND SAFETY Principal Investigator & Institution: Petrides, Georgios; Associate Professor; Long Island Jewish Medical Center 270-05 76Th Ave New Hyde Park, Ny 11040 Timing: Fiscal Year 2002; Project Start 01-FEB-1997; Project End 30-APR-2004 Summary: (Provided by Applicant): This is a competing renewal application seeking two years of additional funding to complete the ongoing multi-site study, "Continuation ECT versus Pharmacotherapy." The goal of this research is to compare continuation ECT with an aggressive combination pharmacotherapy strategy (nortriptyline plus lithium) in the prevention of depressive relapse after successful ECT for major depression. As of May 30, 2001, we have successfully enrolled 470 patients into the acute ECT phase of the study (Phase I) and 159 patients into the two treatment arm randomized phase (Phase II). This represents 73 percent of the necessary recruitment target. An additional 56 randomized patients will be enrolled to meet the target randomized sample size of 216. Completion of patient recruitment, follow-up, and analysis of results can be accomplished with the additional 24 months requested in this application. Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive disorder (MDD). Relapse after acute phase ECT or pharmacotherapy remains a major public health problem. Recent studies show an alarmingly high rate of relapse after ECT despite conventional pharmacotherapy (C-PHARM). Continuation ECT (C-ECT) is also in widespread clinical use, however, its efficacy and safety have never been rigorously tested. The role of C-ECT in relapse prevention of seriously ill patients with MDD urgently needs to be defined. The ongoing study is a prospective, six-month, randomized clinical trial in which patients with MDD who remit with an acute course of bilateral ECT are randomized to one of two treatment arms: C-PHARM (nortriptyline + lithium) or C-ECT. The major hypothesis is that C-ECT will more effectively prevent relapse than C-PHARM. The two continuation therapies also will be compared in their

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Nortriptyline

effects on cognitive performance, global functioning, side effects, and perceived health status. Study design features include rigorous remitter criteria, blinded neuropsychological assessments, rigorous quality control procedures including independent, blind rating of videotaped Hamilton Depression Rating Scale and SCID interviews, and independent oversight of data collection and analysis. When completed, this project will provide the first and definitive data on the role of C-ECT in the treatment of serious affective illness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTINUATION OF ECT VS PHARMACOTHERAPY--EFFICACY AND SAFETY IN MAJOR DEPRESSION Principal Investigator & Institution: Rummans, T A.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002 Summary: Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive disorder (MDD) that is helpful for patients with the most severe forms of affective illness. Relapse after successful acute phase ECT or pharmacotherapy practice is to prescribe an antidepressant (e.g., a tricyclic, a selective serotonin reuptake inhibitor (SSRI) or lithium) as continuation therapy. Recent studies show an alarmingly high relapse rate after ECT despite conventional continuation pharmacotherapy (C-PHARM). Continuation ECT (C-ECT) is also in widespread clinical use, however, its efficacy and safety have never been rigorously tested. The role of C-ECT in relapse prevention of seriously ill patients with MDD urgently needs to be defined. Currently, there is no information on the relative efficacy and safety of C-ECT in comparison to the traditional approach of C-PHARM. In a prospective, six-month, randomized single blind trial, we will compare the relative efficacy of an aggressive pharmacological strategy [nortriptyline and lithium in combination, and C-ECT in the prevention of relapse in patients with MDD who have responded to ECT. The major hypothesis is that C-ECT will more effectively prevent relapse than C-PHARM. Investigators at 4 sites will randomize 228 patients over 4 years. Raters at each site will evaluate symptoms and side effects. On the basis of edited videotapes obtained at regular intervals, a siteindependent, blinded evaluator also will assess symptoms. A neuropsychological battery will be administered prior to acute phase ECT, shortly after the ECT course, 3months after the end of acute phase treatment, and at the end of the 6-month continuation trial. These continuation therapies will be compared in their effects on relapse, cognitive performance, global functioning, side effects, and perceived health status. NOR and LI levels will be optimized by blood level monitoring. Bilateral ECT, at progressively increasing intervals, will be used for C-ECT. Methods are included to ensure the integrity of clinical diagnoses, symptom severity assessment, data collection and entry, and treatment delivery. In all patients, surreptitious use of prescription or recreational drugs will be monitored by urine testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CLINICAL PSYCHOPHARMACOLOGY Principal Investigator & Institution: Young, Robert C.; President; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2003 Summary: The Psychopharmacology/Biochemistry Laboratory (PBL) Core directed by Dr. Young, will comprise a research biochemist and a technician. It will utilize existing

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facilities for high performance liquid chromatography (HPLC) and radioimmunoassay (RIA). The PBL Core will serve as a resource for other investigators, providing drug assays and catecholamine neurotransmitter measures, developing additional assay procedures, and serving a consultative role. The PBL will offer training in HPLC, RIA and other laboratory techniques for research fellows and other staff. The PBL will also conduct a research program focused on pharmacologic in geriatric major depression and mania. The PBL research program represents an extension of ongoing studies of nortriptyline (NT) in major depression and of geriatric mania. The goals are to improve guidelines for clinical and research use of NT and lithium (Li) salts by examining concentration-effect relationships and to examine changes in catecholamine neurotransmitter measures during treatment. Differences in patients with cognitive impairment or abnormal brain morphology are evaluated. The first of two pilot studies proposed will examine relationships between plasma NT and 10-hydroxynortriptyline (10-OH- NT) concentrations and therapeutic response and changes in noradrenergic function in geriatric major depressives, with and without cognitive impairment, treated with fixed dose. Differences in patients with large ventricle-brain ration are also tested. The second pilot study will examine therapeutic response to conventional vs. low plasma Li in geriatric manic patients with and without cognitive impairment. Efficacy and change in noradrenergic and dopaminergic measures will be compared in the two treatment groups; differences in patients with cognitive impairment will be examined. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--GERIATRIC PSYCHOPHARMACOLOGY Principal Investigator & Institution: Pollock, Bruce G.; Professor of Psychiatry and Pharmacology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002 Summary: This Core focuses on antidepressant studies and is particularly concerned with the assay of nortriptyline and paroxetine platelet 5-HT reuptake interrupted by the use of antidepressant medication, including a double- blind study of paroxetine, a potent innovative serotonin reuptake inhibitor versus the more generally used nortriptyline. The goal of the study is to document pharmacokinetic changes in elderly adults. one primary goal of the present Core is to provide support for other cores and relevant projects of the investigators focused on pharmacokinetic/pharmacodynamic assessments, and to provide relevant instruction for students and area nursing homes, in vivo (phenotyping) and in vitro (drug metabolic assays) studies of cytochrome P450 function, an enzyme responsible for metabolism of significant antidepressants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COURSE OF TREATMENT RESISTANT DEPRESSION Principal Investigator & Institution: Rosenbaum, Jerrold F.; Associate Professor; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Nortriptyline

Project Title: DRUG TREATMENT OF DEPRESSION IN THE NURSING HOME AGED Principal Investigator & Institution: Katz, Ira R.; Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-AUG-1993; Project End 06-SEP-2003 Summary: We are proposing to conduct a study of the effectiveness and safety of nortriptyline treatment of depression in two samples of elderly nursing home residents with symptoms of major depression, those who are cognitively intact and those with coexisting dementia. We propose to enter 60-65 patients in each group and estimate that the final sample will include 50 treatment completers in each group. Although all subjects will have symptoms of major depression, the sample will vary considerably in its clinical features. Patients with bipolar disease and those with psychotic depressions will be excluded but the admission criteria will allow investigation of patients of varying severity and varying duration of the current episode, the presence or absence of features of melancholia, and early versus late onset, as well as differences in comorbid medical disorders and dementia. The treatment protocol will consist of two phases. In Phase One, patients will be treated under single blind conditions with a placebo for a period of one week and then they will be randomly assigned to ten weeks of treatment with one of two dose regimens of nortriptyline chosen to ensure a wide distribution of final steady state plasma levels; one regimen will be limited to "low" doses, up to 10 mg/day, while the other will allow more "usual" doses, up to 60 mg/day. In Phase Two, non-responders from Phase One will be treated for another eight week period with doses of nortriptyline adjusted to achieve plasma levels in the range 80-120 ng/ml, while patients with plasma levels in this range will be continued. Patients will be monitored during treatment with assessment of plasma levels of nortriptyline (total and free), active metabolites, and binding proteins, as well as measures of symptoms, affective, cognitive, functional, nutritional, and medical status. The data obtained from these studies will be used to provide clinicians with practical guidelines for the treatment of depression in the frail elderly, both in the nursing home and the community, to use plasma level-response relationships as a probe for identifying treatment- relevant types of depression, and to further develop fixed dose treatment with nortriptyline as a standard control for use in subsequent treatment studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FOREBRAIN MECHANISMS IN CHRONIC NON-NEUROPATHIC PAIN Principal Investigator & Institution: Casey, Kenneth L.; Professor; Neurology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2004 Summary: Psychophysical studies have shown that patients with fibromyalgia (FM) have cutaneous heat and pressure thresholds that are lower and ratings of these stimuli that are higher than normal. Patients with the chronic pain of arthritis (CPA) have similar, but less severe, hypersensitivity to cutaneous heat and pressure stimuli. These abnormalities may reflect an amplification of forebrain nociceptive processing due to continual nociceptive input (CPA), or primary adaptive changes in CNS nociceptive processing (FM). We will obtain psychophysical measurements of the thresholds and perceived intensities and unpleasantness of cutaneous heat and somatic pressure stimuli in all subjects. We will use H215O positron emission tomography (PET) to test the overall hypothesis that FM and CPA patients have correspondingly larger stimulus-

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evoked increases in regional cerebral blood flow (rCBF) within bilateral volumes of interest (VOI; thalamus, insula, and the sensorimotor (S1/M1), S2, anterior cingulate, and premotor (B6) cortices) than normal subjects. Because FM occurs primarily in women, we will study two groups of right-handed female patients: 20 with FM and 20 with CPA, and compare their rCBF responses to those of 20 normal women within the same age range (20-50 years). Patients will rate their clinical pain at or above 4 on a visual analog scale of pain (VAS; 0-10) and will complete a short-form McGill Pain Questionnaire (VAS, MPQ). Standard VOI will be developed in normal subjects from peak rCBF increases within the above structures in response to heat stimuli applied at 35EC, heat pain threshold (HPT), heat pain tolerance (Hptol), and at 3 additional intensities anchored symmetrically around HPT and below Hptol. These standard VOI and stimulus intensities will be used to determine the correlation between rCBF increases and applied stimulus intensity and perceived unpleasantness, as estimated with a VAS, in normal subjects and in patients with FM or CPA who have not been taking opioid analgesic or psychoactive medication for one month. We predict that the psychophysical responses, and the rCBF responses within one or more VOI will be larger in FM and CPA patients than in normal subjects. These same studies will be performed again after all patients have been taking nortriptyline (NT) and/or physical therapy (PT) for approximately one year. Normal subjects will take NT for 3 weeks before the second PET scan (1 year later). We predict that both patient groups, but not normal subjects, will show clinical pain scores, stimulus-evoked psychophysical responses, and rCBF responses, in one or more VOI, that are less than those obtained before NT or PT treatment. We will also examine differences between FM and CPA patients. Support for the overall and correlative hypotheses will constitute evidence that, in the absence of peripheral causes, the pain experienced by FM and CPA patients is due, at least in part, to abnormal central nociceptive processing mechanisms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ISOTOPE DILUTION GAS CHROMAT MASS SPECT MEASURE OF TRICYCLIC ANTIDEPRESSANT Principal Investigator & Institution: Way, Barbara; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002 Summary: Stable isotope dilution gas chromatographic-mass spectrometric (GC-MS) measurement of tricyclic antidepressants (TCA) is a useful alternative to high performance liquid chromatographic (HPLC) methods when interfering substances prevent accurate quantitation by HPLC. For satisfactory GC-MS analysis, secondary amine TCA must be derivatized. Commonly employed trifluoroacetyl and heptafluorobutyryl derivatives are relatively unstable and cause rapid deterioration of capillary gas chromatography (GC) columns. We have therefore examined 4carbethoxyhexafluorobutyryl chloride (CHFB-Cl) as an alternate derivatizing agent and have developed a stable isotope dilution GC-MS method employing ring-labeled [2H4]desipramine and [2H4]-imipramine internal standards which permits measurement of desipramine, nortriptyline, imipramine, and amitriptyline in plasma samples containing one or all of these analytes. The GC-MS assay is linear for each analyte from the lower limit of quantit ation (25 ng/mL) up to 1500 ng/mL and correlates well with HPLC measurements. The GC-MS analytic coefficient of variation was 9.7 1 1.3% for all analytes considered together. Although interferences are observed in the HPLC assay, thioridazine, perphenazine, cyclobenzaprine, or norcyclobenzaprine do not interfere with GC-MS measurements of the TCA examined here. The stability of the CHFB

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derivative of secondary amine TCA was found to be superior to that of the trifluoroacetyl derivatives of these compounds. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOW-DOSE NORTRIPTYLINE IN SMOKING CESSATION Principal Investigator & Institution: Remenchik, Ellen; Occupational & Environmental Medicine; University of Texas Hlth Ctr at Tyler 11937 Us Highway 271 Tyler, Tx 75708 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Nortdptyline hydrochloride, available as a generic drug in the US for many years, has recently been shown to be efficacious in the treatment of nicotine addiction associated with cigarette smoking. It is a tricyclic antidepressant that is believed to modulate noradrenergic neurotransmission. Currently, buproprion is the only non-nicotine therapy approved by the FDA, and is believed to have a similar mechanism, although these mechanisms are not completely understood. One putative explanation of moderately higher quit-rates observed for anti-depressive therapy is the following: smoking and depression are highly linked, and subsequent relief of depression, which may be especially acute just after smoking cessation target date, may facilitate continued abstinence. This notion has not been supported as strongly, however, where psychological interventions have been substituted as a relief for depression. This suggests there may exist an ill characterized molecular mechanism which may be providing more direct benefit for continued smoking cessation. On the other hand, even if the benefit is indirectly influenced through changes in mood states, it has been informally suggested that relief of anxiety, in addition to relief of depression, may play a similar role. Nortriptyline is a considerably less expensive alternative to buproprion, and affords comparable efficacy, although it does have a more problematic safety profile. Although generally non-addictive, nortriptyline, like all tricyclics, can have serious anticholinergic side effects, and an overdose is potentially lethal. It is unknown whether low doses of nortriptyline, which may be sub-therapeutic for relief of depression/anxiety, might yet be therapeutic for smoking cessation. The safety profile of lower doses, which might be expected to be more favorable than nominal recommended doses, has not been examined in the context of a smoking cessation study. Doses are typically titrated up to 50-150 mg/day, the maximum recommended dose. Previous studies have used titrated doses up to fixed target doses, typically 75 mg/day. In this pilot project, we are proposing a randomized, placebo-controlled, and double-blinded dose-response clinical trial of nortriptyline utilizing fixed target daily dose levels of 0 mg (placebo), 25 mg, 50 mg, and 75 mg. The specific aims are (1) to describe and determine the safety profile of nominal to low dose levels not usually prescribed; (2) to determine how relief of depression and anxiety is related to dose; and (3) to determine whether there is mere evidence of the existence of a molecular or other mechanism which works independently of mood states, that improves quit rates. If this research is successful, more thorough studies may be warranted. It could generate novel hypotheses and more enlightened directions for cessation research. More pragmatically, it might promote the use of nortriptyline under safer doses, and could remove insurance coverage barriers for smoking cessation therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SMOKERS

MAINTAINING

NONSMOKING:

TREATMENT

OF

15

OLDER

Principal Investigator & Institution: Hall, Sharon M.; Professor & Vice Chair; Langley Porter Psychiatric Institute; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 30-SEP-2001; Project End 28-FEB-2007 Summary: (provided by applicant) The goal of this line of research is to develop and evaluate interventions that maintain nonsmoking, and in so doing, better understand the processes leading to smoking cessation and relapse. This is a competing continuation application for a line of research that has produced 42 journal articles, 18 book chapters, and 27 abstracts over a 20-year period. Certain population subgroups are at risk for continued smoking and relapse; one subgroup is smokers 50+ years of age, who are increasing in number as the general population ages. Smoking is a serious health risk factor for older individuals. Smoking cessation dramatically reduces mortality and morbidity from cancer, cardiac disease, and other illnesses in this age group. Recent practice guidelines call for research on pharmacological strategies for smokers 50+ years. Data indicates that these smokers are highly nicotine dependent and have a high prevalence of "subsyndromal depression." Our group has worked extensively with nicotine dependent and depressed smokers. This earlier work will be used to inform an innovative intervention. Thus, the specific aims of the proposed work are to test a series of hypotheses about the efficacy and cost-effectiveness of four interventions for older smokers. Participants (N=432) will be randomly assigned to one of four intervention conditions: (1) counseling control; (2) standard (12 week) Nicotine Replacement Therapy (NRT); (3) extended (52 week) psychosocial support/standard NRT; (4) extended psychosocial support/extended (52 week) NRT. Participants will be assessed at baseline on smoking, nicotine dependence, diagnosis, demographics, mood, social support, health status, motivation for change, and drug and alcohol use. At weeks 12, 24, 36, 52 and 104, participants will be assessed on self-reports of smoking verified by carbon monoxide and anatabine/anabasine, and measures of mood, social support, health status and motivation for change. Urinary cotinine will be collected at week 104. The prototypical data analysis strategy is GEE. Also, we will complete exploratory analyses to determine those variables that best predict smoking treatment outcome, and differential response to the extended interventions in older smokers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAINTENANCE THERAPIES IN LATE LIFE DEPRESSION Principal Investigator & Institution: Reynolds, Charles F.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-MAR-1989; Project End 29-FEB-2004 Summary: (Adapted from the Applicant's Abstract): The very old represent the fastest growing segment of the elderly population, those with the most brittle antidepressant treatment response, and yet the least studied in randomized clinical trials. Hence, information on the optimal strategies for the long-term clinical management of such patients is greatly needed. In our recently completed studies of maintenance therapies in late-life depression (MTLD-1), we have learned that nortriptyline (NT) and interpersonal psychotherapy (IPT), either alone or in combination, are substantially better than placebo In preventing recurrences of geriatric major depression and that combined treatment works better than monotherapy in maintaining recovery. However, long-term treatment response in patients aged 70 and above appears much more

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variable and brittle than in 60-69 year-olds, with monotherapy performing less well than combined treatment with medication and psychotherapy. Despite increasing use of SSRI antidepressants in old-age depression, there are no controlled evaluations of their longterm efficacy. Thus, in MTLD-2, we propose to test the hypothesis that combined maintenance treatment with paroxetine (PX) and IPT will be superior to either alone and to placebo in maintaining recovery and in reducing long-term treatment-response variability in the 70+ year old patients. As well, cost-benefit analyses of combined versus monotherapeutic strategies are necessary and also will be provided by MTLD-2. Finally, in order to address the question: 'Which treatments work best for which patients?,' we will determine moderators of long-term treatment- response variability in geriatric depression, including cognitive impairment and brain structural changes. Two hundred subjects aged 70 and above with current major depression (non-psychotic, nonbipolar) will receive acute and continuation treatment with PX and IPT. Patients who recover (estimated n = 125) will receive maintenance treatment, with random assignment to one of four conditions: 1) medication clinic + PX; 2) medication clinic + placebo (PBO); 3) IPT + PX; and 4) IPT + placebo. Maintenance treatment will last two years or until recurrence of major depression, whichever occurs first. Rates of recurrence and time to recurrence in each condition will be contrasted via survival analysis. We will also examine the cost- effectiveness of combined versus monotherapy in maintenance treatment and determine moderating variables of long-term treatment response. This proposal is the competing renewal of MH43832. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPTIMIZATION OF ELECTROCONVULSIVE THERAPY Principal Investigator & Institution: Haskett, Roger E.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-JAN-2006 Summary: (Adapted from Applicant's Abstract): Patients treated with electroconvulsive therapy typically present with the most severe forms of major depression. Likely due to the increasing representation of medication-resistant patients, ECT response rates have diminished relative to earlier decades. This diminished response rate and early relapse following response are critical clinical problems in the use of ECT. Using the CSMD mechanism, this project addresses two key issues in the optimization of ECT in patients with major depression: whether patients treated with ECT should receive concurrent treatment with antidepressant medications (to enhance ECT outcome and/or prevent early relapse) and the role of electrode placement (high dosage right unilateral (RUL) ECT versus low dosage bilateral (BL) ECT) in maximizing short-term response and minimizing side effects. Patient enrollment, treatment, and evaluation will be conducted at Wake Forest University, Washington University, and the Western Psychiatric Institute and Clinic, with staff at the New York State Psychiatric Institute responsible for study coordination and monitoring. The study uses a random assignment, double-masked, parallel group design with two phases. In Phase 1, stratified by the classification of medication resistance, patients are randomized to concurrent treatment with nortriptyline (NT, n=210], venlafaxine (VEN, n=210) or placebo (PL, n=210), and simultaneously to high dosage (6 times threshold) RUL ECT (n=315) or low dosage (1.5 times threshold) BL ECT (n=315). Based on substantial preliminary data, the hypotheses will be tested that (1) compared to PL, concurrent NT or VEN results in superior symptomatic response, without a meaningful difference in side effects, and (2) RUL and BL ECT are equal in efficacy, but with significant advantages to high dosage RUL ECT in the magnitude of short- and long-term cognitive side effects. Support for these

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hypotheses in a large and diverse sample should have widespread ramifications for clinical practice. In the Phase 2 double-masked, 6-month continuation trial, remitters who received PL during ECT are randomized to NT and lithium (LI) or to VEN-LI. Patients who had been randomized to concurrent NT or VEN during ECT receive continuation treatment with NT-LI or VEN-LI, respectively. Standard practice involves the discontinuation of antidepressant medications prior to ECT, the abrupt discontinuation of ECT upon response, and then a switch to continuation pharmacotherapy. This practice likely diminishes response to ECT and heightens relapse in the first several weeks following ECT. Phase 2 of this study, centering on the comparison of patients treated with an antidepressant medication (NT or VEN) or placebo during ECT, will provide the very first data on whether starting an antidepressant medication from the beginning of the ECT course reduces the rate of early relapse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISORDERS

PAIN

MANAGEMENT

IN

TEMPOROMANDIBULAR

JOINT

Principal Investigator & Institution: Haythornthwaite, Jennifer A.; Associate Professor; Psychiatry and Behavioral Scis; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-SEP-2001; Project End 31-AUG-2006 Summary: The primary goal of the proposed project is to test the efficacy of psychological interventions, a pharmacological intervention, and the combination of these interventions in reducing pain and improving function in persons with temporomandibular disorders (TMD). Since psychological interventions are costly and require expertise that is frequently unavailable in primary care settings, the proposed project will also examine the efficacy of a minimal contact/self help psychological intervention based on cognitive-behavioral therapy for pain management. In addition to examining the separate and combined effects of psychological and pharmacological interventions for TMD pain, the proposed study will examine whether the minimal contact cognitive-behavioral intervention can accomplish comparable reductions in pain and improvements in function relative to the therapist-administered treatment. Since patients with TMD pain show high utilization of health care services, this study will examine the cost-effectiveness of psychological and pharmacological treatments. The study will also examine whether individual patient characteristics, such as depression, predict response to treatment and whether treatment gains are maintained at 6-month follow-up. Persons with persistent facial pain due to TMD for 3 months or longer will be enrolled in this randomized controlled study which incorporates a 2 group (nortriptyline vs. active placebo - benztropine) by 3 group (cognitive-behavioral vs. minimal contact CBT vs. education and usual care) design. Following completion of the 8-week active phase of treatment, patients will enter a 6-month maintenance and followup period. Outcome measures will assess pain and physical and psychological functioning. Findings derived from this project will lead to further studies that determine which treatments, or combinations of treatments are effective for which subgroups of patients with TMD. Evaluation of a treatment approach combining commonly used psychological and pharmacological approaches promises to promote the development of truly effective pain management programs, contribute to the management of these individuals, and improve the quality of their lives. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POSTPARTUM DEPRESSION--NORTRIPTYLINE VS SERTRALINE Principal Investigator & Institution: Wisner, Katherine L.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-APR-1997; Project End 31-MAR-2004 Summary: Depression which interferes with maternal role functioning occurs in 10 to 15 percent of postpartum women. This disorder causes personal and family suffering at a time when adaptation to the tasks of parenthood is critical. Rapid provision of effective treatment is imperative to prevent the consequences of maternal illness. However, there are no controlled pharmacologic treatment studies of women with postpartum major depression (PPMD). The purpose of this study is to conduct a double-blind, randomized clinical trial of sertraline (SERT) compared to nortripytyline (NTP) for the treatment for PPMD. The proposed study is a fixed-dose, 8 week clinical trail. The hypothesis is that a SERT tnan to NPT as defined by measures of symptom reduction and psychosocial function. Secondary hypotheses are: 1) the side effect burden of women treated with SERT will be less than with NTP; 2) depressed women with aggressive obsessional thoughts will respond more favorably to SERT; and 3) specific clinical variables will be associated with drug response (depression severity, personality disorder, marital disaffection, and psychosocial problems). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF GERATRIC DEPRESSION Principal Investigator & Institution: Alexopoulos, George S.; Professor and Vice Chair; Psychiatry; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 01-MAY-1994; Project End 31-JAN-2004 Summary: As an increasing number of elderly are treated for depression, systematic data are crucially necessary to help guide continued clinical care. This study will: 1) determine clinical and neuroradiographic predictors of early relapse and recurrence; 2) test the efficacy and safety of maintenance nortriptyline (NT); and 3) identify those plasma levels of 10- OH-NT (an NT metabolite) associated with low protective power against relapse and recurrence and/or with cardiovascular and cognitive side effects. Thus, the study is expected to help clinicians identify patients in greatest need for longterm drug treatment, assess the risk-benefit ratio of preventive NT therapy, and refine guidelines for the NT prescription. Subjects will be 125 elderly patients who have recovered from an episode of non-delusional major depression after acute treatment with NT (50% of subjects will have mild to moderate dementia and the remainder will not have cognitive impairment). Upon completion of a continuation phase (4 months after recovery) with NT at plasma levels of 80-120 ng/ml, subjects will be randomly assigned to NT or placebo maintenance (after 4 months from recovery) gradually over 10 weeks. The principal methods of data analysis will be generalized regression models for repeated measures and survival analysis. We have previously characterized the heterogeneity of geriatric depression, tested its response to acute pharmacologic treatments, and described its course under naturalistic conditions. This pioneering controlled-treatment study therefore represents a logical next step. While well aware of the methodological problems and confounds posed by studying a "sick and old" population, we bring to this project a committed and experienced research team, the support and structure of a Developing CRC specifically targeted to study the outcomes of geriatric affective disorders, and our established recruitment procedures in a remarkably large psychiatric inpatient/outpatient geriatric service. Accordingly, we are

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well positioned to meet the challenges inherent in this difficult but important area of research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DEPRESSION IN PARKINSON'S DISEASE Principal Investigator & Institution: Menza, Matthew A.; Psychiatry; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 08854 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by the applicant): Depression is the most common neuropsychiatric disorder found in patients with Parkinson's Disease (PD). It causes immense personal suffering, and is associated with increased disability and caregiver burden. Despite the adverse consequences of depression in patients with PD, there are virtually no empirical data to guide clinical treatment. In the absence of data, the SSRIs are apparently used as the first-line treatment, despite concerns about efficacy, safety, and tolerability in this population. This proposal is for a pilot study to establish the feasibility of, and generate sufficient data to plan, a larger clinical trial that will be able to inform clinical treatment of these patients. This pilot trial will (AIM 1) examine the feasibility of a larger trial, and establish (AIM 2) the effect size for short-term efficacy of anti-depressants, compared to placebo, in this population. It will also (AIM 3) evaluate the effect of long-term depression treatment on quality-of-life. This will be done in the context of a placebo-controlled, double-blind, parallel group, flexible dose trial of an SSRI (Paroxetine), a tri-cyclic (Nortriptyline) and placebo in acute (8 weeks) and longterm treatment (6 months). A total of 75 patients with PD (without significant motor fluctuations or Dementia) and depression (major depression or Dysthymia) will be randomized to each of the three arms in a balanced design. The feasibility issues that will be explored include recruitment, retention, drug tolerability, and the ability to maintain the blind. The outcomes that will be explored for the acute phase include changes in the Hamilton Depression Rating Scale (HAM-D) score, and the percent of patients who are responders (>50% improvement in the HAM-D, or < 10 on the HAMD). The outcome variables explored for the long-term phase include the Parkinson's Disease Questionnaire and the Medical Outcome Study Short Form. Secondary analyses will involve the exploration of anxiety, motor disability, sleep, cognition, and individual or clusters of symptoms that are responsive to treatment in order to facilitate planning a subsequent, full-scale clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OUTCOME OF VASCULAR DEPRESSION Principal Investigator & Institution: Sheline, Yvette I.; Associate Professor; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (provided by applicant): The treatment of major depression in late life (LLD) is an important health problem with a large and growing number of affected individuals. A significant subset of patients with LLD, particularly those with cerebrovascular risk factors (VRF)s, have subcortical gray matter (SCGMH) or frontal deep white matter (FDWMH) hyperintensities on brain mRI scans. Naturalistic studies suggest that such changes may be associated with poor acute and long-term antidepressant treatment response. However, the prognostic significance of brain MRI findings has not been evaluated systematically in prospective treatment trials. Similarly, studies have indicated that LLD patients frequently have deficits in

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Nortriptyline

Initiation/Perseveration (IP) and other tests of frontal lobe function. An elegant longitudinal study with nortriptyline has demonstrated that frontal executive dysfunction is associated with poor acute response as well as a greater risk for relapse/recurrence in LLD. However, the generalizability of this important finding to other classes of antidepressants, such as the widely used SSRIs, is not known. The interaction between frontal brain lesions and executive function deficits in LLD is also not fully studied. The proposed study will be the first large-scale prospective trial to simultaneously test the effects of both specific neuroanatomical and neuropsychological factors on course of response, remission rate as well as on broader measures of health outcomes in LLD. We propose to conduct a collaborative 12-week acute treatment trial with sertraline in 320 elderly (age greater than 60) patients with major depression at Duke University Medical Center and Washington University Medical Center. In a sample chosen to balance generalizability and scientific rigor, we will test the hypotheses that: 1) greater lesion severity on MRI will predict reduced treatment response, and 2) greater lesions severity on MRI willbe correlated with frontal executive dysfunction. In secondary aims, we will test the effects of lesion volume/location and frontal executive dysfunction on treatment response. In addition, we will test the effect of interactions of MRI-lesions, vascular risk factors and executive dysfunction on treatment response. The proposed trial will provide information of value to the practitioner and also provide data to build a more comprehensive model of the prognostic impact of frontal-subcortical brain changes on the outcome of late-life depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OUTCOMES OF VASCULAR DEPRESSION Principal Investigator & Institution: Doraiswamy, Pudugramam; Psychiatry; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (provided by applicant): The treatment of major depression in late life (LLD) is an important health problem with a large and growing number of affected individuals. A significant subset of patients with LLD, particularly those with cerebrovascular risk factors (VRF)s, have subcortical gray matter (SCGMH) or frontal deep white matter (FDWMH) hyperintensities on brain mRI scans. Naturalistic studies suggest that such changes may be associated with poor acute and long-term antidepressant treatment response. However, the prognostic significance of brain MRI findings has not been evaluated systematically in prospective treatment trials. Similarly, studies have indicated that LLD patients frequently have deficits in Initiation/Perseveration (IP) and other tests of frontal lobe function. An elegant longitudinal study with nortriptyline has demonstrated that frontal executive dysfunction is associated with poor acute response as well as a greater risk for relapse/recurrence in LLD. However, the generalizability of this important finding to other classes of antidepressants, such as the widely used SSRIs, is not known. The interaction between frontal brain lesions and executive function deficits in LLD is also not fully studied. The proposed study will be the first large-scale prospective trial to simultaneously test the effects of both specific neuroanatomical and neuropsychological factors on course of response, remission rate as well as on broader measures of health outcomes in LLD. We propose to conduct a collaborative 12-week acute treatment trial with sertraline in 320 elderly (age greater than 60) patients with major depression at Duke University Medical Center and Washington University Medical Center. In a sample chosen to balance generalizability and scientific rigor, we will test the

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hypotheses that: 1) greater lesion severity on MRI will predict reduced treatment response, and 2) greater lesions severity on MRI willbe correlated with frontal executive dysfunction. In secondary aims, we will test the effects of lesion volume/location and frontal executive dysfunction on treatment response. In addition, we will test the effect of interactions of MRI-lesions, vascular risk factors and executive dysfunction on treatment response. The proposed trial will provide information of value to the practitioner and also provide data to build a more comprehensive model of the prognostic impact of frontal-subcortical brain changes on the outcome of late-life depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VASCULAR DEPRESSION AND MAGNETIC STIMULATION THERAPY Principal Investigator & Institution: Robinson, Robert G.; Professor and Head; Psychiatry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 18-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant) Vascular depression in the elderly has been shown to be more refractory to treatment and to have a poorer outcome than non-vascular depression. This study will examine the effectiveness of rapid-transcranial magnetic stimulation over 3 weeks followed by therapeutic blood levels of nortriptyline in the treatment of vascular depression and maintenance of remission over 12 weeks. Patients who have failed at least one treatment for vascular depression will be randomized using double blind controls to treatment with rapid transcranial magnetic stimulation (rTMS) followed by nortriptyline or sham rTMS followed by nortriptyline. We have developed techniques for the uniform administration of rTMS in anatomical location and spatial alignment of the stim coil. We predict that patients given rTMS will have a higher response rate to treatment than placebo rIMS and that over the 9 weeks of nortriptyline they will maintain a lower Ham-D score than the patients given nortriptyline alone. Prior to beginning nortriptyline treatment patients will be genotyped using P450 oligonucleotide microassays for substitutions that affect the CYP2D6 enzyme, which metabolizes nortriptyline. We predict that the patient with null alleles will metabolize nortriptyline so slowly that their side effects ratings will be very high and they will drop out of the study. Patients with alleles encoding extensive or rapid metabolism will relapse because they will be unable to maintain a steady nortriptyline level. Outcome measures will involve response rate to each treatment, relapse rates for each treatment, the size, number, or location of the vascular lesion or the amount of regional brain atrophy or other demographic or prior historical data. We will also examine outcome related to treatment as measured by improvement in activities of daily living, quality of life and cognitive function. We predict that patients given rIMS will improve their cognitive function more than sham treated patients and that the amount of frontal brain atrophy will correlate with both response of depression (i.e. more atrophy lower response rate) and cognitive function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with nortriptyline, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “nortriptyline” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for nortriptyline (hyperlinks lead to article summaries): •

A common P-glycoprotein polymorphism is associated with nortriptyline-induced postural hypotension in patients treated for major depression. Author(s): Roberts RL, Joyce PR, Mulder RT, Begg EJ, Kennedy MA. Source: The Pharmacogenomics Journal. 2002; 2(3): 191-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12082591

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A controlled study of nortriptyline in children and adolescents with attention deficit hyperactivity disorder. Author(s): Prince JB, Wilens TE, Biederman J, Spencer TJ, Millstein R, Polisner DA, Bostic JQ. Source: Journal of Child and Adolescent Psychopharmacology. 2000 Fall; 10(3): 193-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11052409

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A differential response to nortriptyline and fluoxetine in melancholic depression: the importance of age and gender. Author(s): Joyce PR, Mulder RT, Luty SE, McKenzie JM, Rae AM. Source: Acta Psychiatrica Scandinavica. 2003 July; 108(1): 20-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12807373

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A double-blind randomized comparison of nortriptyline and paroxetine in the treatment of late-life depression: 6-week outcome. Author(s): Mulsant BH, Pollock BG, Nebes RD, Miller MD, Little JT, Stack J, Houck PR, Bensasi S, Mazumdar S, Reynolds CF 3rd. Source: The Journal of Clinical Psychiatry. 1999; 60 Suppl 20: 16-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10513853

3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A double-blind randomized comparison of nortriptyline plus perphenazine versus nortriptyline plus placebo in the treatment of psychotic depression in late life. Author(s): Mulsant BH, Sweet RA, Rosen J, Pollock BG, Zubenko GS, Flynn T, Begley AE, Mazumdar S, Reynolds CF 3rd. Source: The Journal of Clinical Psychiatry. 2001 August; 62(8): 597-604. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11561930

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A double-blind, placebo-controlled assessment of nortriptyline's side-effects during 3-year maintenance treatment in elderly patients with recurrent major depression. Author(s): Marraccini RL, Reynolds CF 3rd, Houck PR, Miller MD, Frank E, Perel JM, Cornes C, Mazumdar S, Kupfer DJ. Source: International Journal of Geriatric Psychiatry. 1999 December; 14(12): 1014-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10607968

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A double-blind, placebo-controlled study of nortriptyline and bromocriptine in male alcoholics subtyped by comorbid psychiatric disorders. Author(s): Powell BJ, Campbell JL, Landon JF, Liskow BI, Thomas HM, Nickel EJ, Dale TM, Penick EC, Samuelson SD, Lacoursiere RB. Source: Alcoholism, Clinical and Experimental Research. 1995 April; 19(2): 462-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7625583

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A double-blind, randomized, controlled study of amitriptyline, nortriptyline and placebo in patients with fibromyalgia. An analysis of outcome measures. Author(s): Heymann RE, Helfenstein M, Feldman D. Source: Clin Exp Rheumatol. 2001 November-December; 19(6): 697-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11791642

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A modified equilibrium dialysis technique for measuring plasma protein binding: experimental evaluation with diazepam and nortriptyline. Author(s): Chow HH, Khor SP, Lee HC, Mayersohn M. Source: Pharmaceutical Research. 1998 October; 15(10): 1643-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9794511

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A placebo-controlled comparison of nortriptyline and phenelzine in maintenance therapy of elderly depressed patients. Author(s): Georgotas A, McCue RE, Cooper TB. Source: Archives of General Psychiatry. 1989 September; 46(9): 783-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2673129

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A placebo-controlled comparison of the effect of nortriptyline and phenelzine on orthostatic hypotension in elderly depressed patients. Author(s): Georgotas A, McCue RE, Friedman E, Cooper TB. Source: Journal of Clinical Psychopharmacology. 1987 December; 7(6): 413-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3323263

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A placebo-controlled randomized clinical trial of nortriptyline for chronic low back pain. Author(s): Atkinson JH, Slater MA, Williams RA, Zisook S, Patterson TL, Grant I, Wahlgren DR, Abramson I, Garfin SR. Source: Pain. 1998 June; 76(3): 287-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9718247

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A post hoc comparison of paroxetine and nortriptyline for symptoms of traumatic grief. Author(s): Zygmont M, Prigerson HG, Houck PR, Miller MD, Shear MK, Jacobs S, Reynolds CF 3rd. Source: The Journal of Clinical Psychiatry. 1998 May; 59(5): 241-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9632035

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A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Author(s): Sullivan M, Katon W, Russo J, Dobie R, Sakai C. Source: Archives of Internal Medicine. 1993 October 11; 153(19): 2251-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8215728

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A randomized trial of nortriptyline for smoking cessation. Author(s): Prochazka AV, Weaver MJ, Keller RT, Fryer GE, Licari PA, Lofaso D. Source: Archives of Internal Medicine. 1998 October 12; 158(18): 2035-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9778204

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A randomized, within-patient, cross-over, placebo-controlled trial on the efficacy and tolerability of the tricyclic antidepressants chlorimipramine and nortriptyline in central pain. Author(s): Panerai AE, Monza G, Movilia P, Bianchi M, Francucci BM, Tiengo M. Source: Acta Neurologica Scandinavica. 1990 July; 82(1): 34-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2239134

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A retrospective study of serum levels and electrocardiographic effects of nortriptyline in children and adolescents. Author(s): Wilens TE, Biederman J, Spencer T, Geist DE. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1993 March; 32(2): 270-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8444754

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A simplified radioimmunoassay of plasma nortriptyline in depressed patients compared with high-pressure liquid chromatography and gas-liquid chromatography. Author(s): Sayegh JF. Source: Neurochemical Research. 1986 February; 11(2): 193-206. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3703101

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A twelve-week, double-blind, randomized comparison of nortriptyline and paroxetine in older depressed inpatients and outpatients. Author(s): Mulsant BH, Pollock BG, Nebes R, Miller MD, Sweet RA, Stack J, Houck PR, Bensasi S, Mazumdar S, Reynolds CF 3rd. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2001 Fall; 9(4): 406-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11739067

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Accelerating antidepressant response in geriatric depression: a post hoc comparison of combined sleep deprivation and paroxetine versus monotherapy with paroxetine, nortriptyline, or placebo. Author(s): Green TD, Reynolds CF 3rd, Mulsant BH, Pollock BG, Miller MD, Houck PR, Mazumdar S, Dew MA, Kupfer DJ. Source: Journal of Geriatric Psychiatry and Neurology. 1999 Summer; 12(2): 67-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10483927

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Active hydroxymetabolites of antidepressants. Emphasis on E-10-hydroxynortriptyline. Author(s): Nordin C, Bertilsson L. Source: Clinical Pharmacokinetics. 1995 January; 28(1): 26-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7712660

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Acute open-trial nortriptyline therapy of bereavement-related depression in late life. Author(s): Pasternak RE, Reynolds CF 3rd, Schlernitzauer M, Hoch CC, Buysse DJ, Houck PR, Perel JM. Source: The Journal of Clinical Psychiatry. 1991 July; 52(7): 307-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2071562

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Adjunctive lithium carbonate in nortriptyline-resistant elderly depressed patients. Author(s): Zimmer B, Rosen J, Thornton JE, Perel JM, Reynolds CF 3rd. Source: Journal of Clinical Psychopharmacology. 1991 August; 11(4): 254-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1918424

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Age and nortriptyline concentrations in plasma ultrafiltrate. Author(s): Young RC, Dhar AK, Hull J, Kakuma T, Alexopoulos GS. Source: International Journal of Geriatric Psychiatry. 2000 November; 15(11): 1009-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11113980

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Akathisia in association with nortriptyline therapy. Author(s): Sabaawi M, Richmond DR, Fragala MR. Source: American Family Physician. 1993 November 1; 48(6): 1024, 1026. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8237726

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Amitriptyline and nortriptyline plasma levels, urinary 3-methoxy-4hydroxyphenylglycol and clinical response in depressed women. Author(s): Corona GL, Cucchi ML, Frattini P, Santagostino G, Schinelli S, Comincioli V, Zerbi F, Fenoglio L, Savoldi F. Source: Neuropsychobiology. 1986; 16(2-3): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3587582

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Amitriptyline pharmacokinetics and clinical response: I. Free and total plasma amitriptyline and nortriptyline. Author(s): Baumann P, Jonzier-Perey M, Koeb L, Le PK, Tinguely D, Schopf J. Source: International Clinical Psychopharmacology. 1986 April; 1(2): 89-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3571944

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An open trial of nortriptyline in women with chronic pelvic pain. Author(s): Walker EA, Roy-Byrne PP, Katon WJ, Jemelka R. Source: International Journal of Psychiatry in Medicine. 1991; 21(3): 245-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1955276

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Aspects of amitriptyline and nortriptyline plasma levels monitoring in depression. Author(s): Corona GL, Cucchi ML, Frattini P, Santagostino G, Schinelli S, Zerbi F, Savoldi F. Source: Psychopharmacology. 1990; 100(3): 334-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2315430

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Aspiration of nortriptyline. Author(s): Johnson DR, Yew D. Source: The American Journal of Emergency Medicine. 1994 May; 12(3): 337-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8179745

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Baseline and 2- to 3-year follow-up characteristics of placebo-washout responders from the nortriptyline study of depressed 6- to 12-year-olds. Author(s): Geller B, Fox LW, Cooper TB, Garrity K. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1992 July; 31(4): 622-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1644724

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Brain morphology and response to nortriptyline in geriatric depression. Author(s): Young RC, Kalayam B, Nambudiri DE, Kakuma T, Alexopoulos GS. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 1999 Spring; 7(2): 147-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10322242

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Bupropion/nortriptyline combination for refractory depression. Author(s): Apter JT, Kushner SF, Woolfolk RL. Source: Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists. 1994 December; 6(4): 255-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7647835

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Cardiac antiarrhythmic effect of nortriptyline. Author(s): Madakasira S. Source: General Hospital Psychiatry. 1986 March; 8(2): 123-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3957018

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Case report: interaction of rifampin and nortriptyline. Author(s): Self T, Corley CR, Nabhan S, Abell T. Source: The American Journal of the Medical Sciences. 1996 February; 311(2): 80-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8615378

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Cerebrospinal fluid levels of amitriptyline, nortriptyline, imipramine and desmethylimipramine. Relationship to plasma levels and treatment outcome. Author(s): Hanin I, Koslow SH, Kocsis JH, Bowden CL, Brunswick D, Frazer A, Carl J, Robins E. Source: Journal of Affective Disorders. 1985 July; 9(1): 69-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3160750

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Child and adolescent nortriptyline single dose kinetics predict steady state plasma levels and suggested dose: preliminary data. Author(s): Geller B, Cooper TB, Chestnut EC, Anker JA, Price DT, Yates E. Source: Journal of Clinical Psychopharmacology. 1985 June; 5(3): 154-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3998205

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Child and adolescent nortriptyline single dose pharmacokinetic parameters: final report. Author(s): Geller B, Cooper TB, Schluchter MD, Warham JE, Carr LG. Source: Journal of Clinical Psychopharmacology. 1987 October; 7(5): 321-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3680602

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Chlorimipramine and nortriptyline but not fluoxetine and fluvoxamine inhibit human polymorphonuclear cell chemotaxis in vitro. Author(s): Sacerdote P, Bianchi M, Panerai AE. Source: General Pharmacology. 1994 May; 25(3): 409-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7926582

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Cimetidine interaction with imipramine and nortriptyline. Author(s): Henauer SA, Hollister LE. Source: Clinical Pharmacology and Therapeutics. 1984 February; 35(2): 183-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6692646

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Cimetidine's effect on steady-state serum nortriptyline concentrations. Author(s): Miller DD, Sawyer JB, Duffy JP. Source: Drug Intell Clin Pharm. 1983 December; 17(12): 904-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6653407

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Citalopram versus nortriptyline in late-life depression: a 12-week randomized singleblind study. Author(s): Navarro V, Gasto C, Torres X, Marcos T, Pintor L. Source: Acta Psychiatrica Scandinavica. 2001 June; 103(6): 435-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11401657

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Clinical and biochemical effects during treatment of depression with nortriptyline: the role of 10-hydroxynortriptyline. Author(s): Nordin C, Bertilsson L, Siwers B. Source: Clinical Pharmacology and Therapeutics. 1987 July; 42(1): 10-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2439250

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Clinical relevance of serum nortriptyline and 10-hydroxy-nortriptyline measurements in the depressed elderly: a multicenter pharmacokinetic and pharmacodynamic study. Author(s): Kin NM, Klitgaard N, Nair NP, Amin M, Kragh-Sorensen P, Schwariz G, Ahmed SK, Holm P, Katona C, Stage K. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1996 July; 15(1): 1-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8797186

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Clinical response and plasma concentrations of amitriptyline and its metabolitenortriptyline in depressive patients. Author(s): Miljkovic B, Pokrajac M, Timotijevic I, Varagic V. Source: Eur J Drug Metab Pharmacokinet. 1996 July-September; 21(3): 251-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8980924

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Cognitive decline with nortriptyline use in a patient with dementia of the Alzheimer's type. Author(s): Bartlome P, King KS, Matsuo F, Wood JS. Source: The Western Journal of Medicine. 1992 January; 156(1): 75-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1734612

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Column switching and high-performance liquid chromatography in the analysis of amitriptyline, nortriptyline and hydroxylated metabolites in human plasma or serum. Author(s): Hartter S, Hiemke C. Source: Journal of Chromatography. 1992 July 24; 578(2): 273-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1400807

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Combination of clomipramine and nortriptyline in the treatment of obsessivecompulsive disorder: a double-blind, placebo-controlled trial. Author(s): Noorbala AA, Hosseini SH, Mohammadi MR, Akhondzadeh S. Source: Journal of Clinical Pharmacy and Therapeutics. 1998 April; 23(2): 155-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9786103

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Comparative efficacy and safety of nortriptyline and fluoxetine in the treatment of major depression: a clinical study. Author(s): Fabre LF, Scharf MB, Itil TM. Source: The Journal of Clinical Psychiatry. 1991 June; 52 Suppl: 62-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2050651

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Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older. Author(s): Desai A, Chibnall JT. Source: Int Psychogeriatr. 1999 September; 11(3): 339-42. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10547133

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Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older. Author(s): Finkel SI, Richter EM, Clary CM. Source: Int Psychogeriatr. 1999 March; 11(1): 85-99. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10189602

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Comparison of imipramine- and nortriptyline-induced orthostatic hypotension: a meaningful difference. Author(s): Roose SP, Glassman AH, Siris SG, Walsh BT, Bruno RL, Wright LB. Source: Journal of Clinical Psychopharmacology. 1981 September; 1(5): 316-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6277997

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Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. Author(s): Roose SP, Laghrissi-Thode F, Kennedy JS, Nelson JC, Bigger JT Jr, Pollock BG, Gaffney A, Narayan M, Finkel MS, McCafferty J, Gergel I. Source: Jama : the Journal of the American Medical Association. 1998 January 28; 279(4): 287-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9450712

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Comparison of risk of orthostatic hypotension in elderly depressed hypertensive women treated with nortriptyline and thiazides versus elderly depressed normotensive women treated with nortriptyline. Author(s): Scalco MZ, de Almeida OP, Hachul DT, Castel S, Serro-Azul J, Wajngarten M. Source: The American Journal of Cardiology. 2000 May 1; 85(9): 1156-8, A9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10781773

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Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. Author(s): Bondareff W, Alpert M, Friedhoff AJ, Richter EM, Clary CM, Batzar E. Source: The American Journal of Psychiatry. 2000 May; 157(5): 729-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10784465

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Concomitant intake of nortriptyline and carbamazepine. Author(s): Brosen K, Kragh-Sorensen P. Source: Therapeutic Drug Monitoring. 1993 June; 15(3): 258-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8333008

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Concurrent liquid chromatographic measurement of fluoxetine, amitriptyline, imipramine, and their active metabolites norfluoxetine, nortriptyline, and desipramine in plasma. Author(s): el-Yazigi A, Raines DA. Source: Therapeutic Drug Monitoring. 1993 August; 15(4): 305-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8236366

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Continuation and maintenance pharmacotherapy in geriatric depression: an opentrial comparison of paroxetine and nortriptyline in patients older than 70 years. Author(s): Walters G, Reynolds CF 3rd, Mulsant BH, Pollock BG. Source: The Journal of Clinical Psychiatry. 1999; 60 Suppl 20: 21-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10513854

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Correlation between nortriptyline and debrisoquine hydroxylation in the human liver. Author(s): von Bahr C, Birgersson C, Blanck A, Goransson M, Mellstrom B, Nilsell K. Source: Life Sciences. 1983 August 15; 33(7): 631-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6410141

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Cost-benefit analysis of prospective pharmacokinetic dosing of nortriptyline in depressed inpatients. Author(s): Simmons SA, Perry PJ, Rickert ED, Browne JL. Source: Journal of Affective Disorders. 1985 January-February; 8(1): 47-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3156911

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CSF and plasma levels of nortriptyline and its 10-hydroxy metabolite. Author(s): Nordin C, Bertilsson L, Siwers B. Source: British Journal of Clinical Pharmacology. 1985 October; 20(4): 411-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4074608

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CSF/plasma ratio of 10-hydroxynortriptyline is influenced by sex and body height. Author(s): Nordin C. Source: Psychopharmacology. 1993; 113(2): 222-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7855185

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CYP2D6 genotyping with oligonucleotide microarrays and nortriptyline concentrations in geriatric depression. Author(s): Murphy GM Jr, Pollock BG, Kirshner MA, Pascoe N, Cheuk W, Mulsant BH, Reynolds CF 3rd. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2001 November; 25(5): 737-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11682257

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Demethylation and hydroxylation of amitriptyline, nortriptyline, and 10hydroxyamitriptyline in human liver microsomes. Author(s): Mellstrom B, von Bahr C. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1981 November-December; 9(6): 565-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6120818

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Determination of amitriptyline and nortriptyline in human liver microsomes with reversed-phase HPLC in vitro. Author(s): Shu Y, Zhu RH, Xu ZH, Zhou HH. Source: Zhongguo Yao Li Xue Bao. 1998 July; 19(4): 343-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10375781

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Determination of amitriptyline and nortriptyline in human plasma by quantitative thin-layer chromatography. Author(s): Haefelfinger P. Source: Journal of Chromatography. 1978 May 1; 145(3): 445-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=659530

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Determination of amitriptylinoxide and its major metabolites amitriptyline and nortriptyline in plasma by high-performance liquid chromatography. Author(s): Terlinden R, Borbe HO. Source: Journal of Chromatography. 1986 October 31; 382: 372-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3782407

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Determination of desmethyl nortriptyline in plasma by gas chromatography before and after treatment with salicylaldehyde. Author(s): Burch JE, Raddats MA, Roberts SG. Source: Journal of Chromatography. 1983 May 13; 274: 350-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6874839

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Determination of nortriptyline in human serum by fully automated solid-phase extraction and on-line high-performance liquid chromatography in the presence of antipsychotic drugs. Author(s): Olesen OV, Plougmann P, Linnet K. Source: J Chromatogr B Biomed Sci Appl. 2000 September 15; 746(2): 233-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11076076

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Dexamethasone suppression test status does not predict differential response to nortriptyline versus amitriptyline. Author(s): Rush AJ, Weissenburger J, Vasavada N, Orsulak PJ, Fairchild CJ. Source: Journal of Clinical Psychopharmacology. 1988 December; 8(6): 421-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3069882

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Differences in effect between nomifensine and nortriptyline. Author(s): Poldinger W, Gammel G. Source: Int Pharmacopsychiatry. 1978; 13(1): 58-68. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=342438

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Differential effect of chlorimipramine and nortriptyline on cerebrospinal fluid metabolites of serotonin and noradrenaline in depression. Author(s): Bertilsson L, Asberg M, Thoren P. Source: European Journal of Clinical Pharmacology. 1974 August 23; 7(5): 365-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4420178

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Disposition of debrisoquine and nortriptyline in Korean subjects in relation to CYP2D6 genotypes, and comparison with Caucasians. Author(s): Dalen P, Dahl ML, Roh HK, Tybring G, Eichelbaum M, Wilkinson GR, Bertilsson L. Source: British Journal of Clinical Pharmacology. 2003 June; 55(6): 630-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12814461

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Disposition of single oral doses of E-10-hydroxynortriptyline in healthy subjects, with some observations on pharmacodynamic effects. Author(s): Bertilsson L, Nordin C, Otani K, Resul B, Scheinin M, Siwers B, Sjoqvist F. Source: Clinical Pharmacology and Therapeutics. 1986 September; 40(3): 261-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3742932

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Distribution of amitriptyline and nortriptyline in blood: role of alpha-1-glycoprotein. Author(s): Amitai Y, Kennedy EJ, DeSandre P, Frischer H. Source: Therapeutic Drug Monitoring. 1993 August; 15(4): 267-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8236360

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Distribution of amitriptyline and nortriptyline in fatal amitriptyline intoxications with different survival times. Author(s): Norheim G. Source: Forensic Sci. 1974 October; 4(2): 187-90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4442828

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Distribution of nortriptyline in human blood: effects of temperature, pH, and drug concentration. Author(s): Slordal L, Lundgren TI, Bessesen A, Sager G. Source: Therapeutic Drug Monitoring. 1987; 9(1): 67-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3576662

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Does lorazepam impair the antidepressant response to nortriptyline and psychotherapy? Author(s): Buysse DJ, Reynolds CF 3rd, Houck PR, Perel JM, Frank E, Begley AE, Mazumdar S, Kupfer DJ. Source: The Journal of Clinical Psychiatry. 1997 October; 58(10): 426-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9375592

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Dosage adjustment from simple nortriptyline spot level predictor tests in depressed patients. Author(s): Montgomery SA, McAuley R, Montgomery DB, Braithwaite RA, Dawling S. Source: Clinical Pharmacokinetics. 1979 March-April; 4(2): 129-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=378500

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Dose and plasma levels of nortriptyline and chlorpromazine in delusionally depressed adolescents and of nortriptyline in nondelusionally depressed adolescents. Author(s): Geller B, Cooper TB, Farooki ZQ, Chestnut EC. Source: The American Journal of Psychiatry. 1985 March; 142(3): 336-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3970271

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Double-antibody enzyme immunoassay for nortriptyline. Author(s): Al-Bassam MN, O'Sullivan MJ, Gnemmi E, Bridges JW, Marks V. Source: Clinical Chemistry. 1978 September; 24(9): 1590-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=99272

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Double-blind comparison of fluoxetine and nortriptyline in the treatment of moderate to severe major depression. Author(s): Akhondzadeh S, Faraji H, Sadeghi M, Afkham K, Fakhrzadeh H, Kamalipour A. Source: Journal of Clinical Pharmacy and Therapeutics. 2003 October; 28(5): 379-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632962

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Double-blind comparison of paroxetine and nortriptyline on the postural stability of late-life depressed patients. Author(s): Laghrissi-Thode F, Pollock BG, Miller MC, Mulsant BH, Altieri L, Finkel MS. Source: Psychopharmacology Bulletin. 1995; 31(4): 659-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8851637

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Double-blind placebo-controlled study of nortriptyline in depressed adolescents using a “fixed plasma level” design. Author(s): Geller B, Cooper TB, Graham DL, Marsteller FA, Bryant DM. Source: Psychopharmacology Bulletin. 1990; 26(1): 85-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2196631

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Double-blind, placebo-controlled study of nortriptyline in depressed children using a “fixed plasma level” design. Author(s): Geller B, Cooper TB, McCombs HG, Graham D, Wells J. Source: Psychopharmacology Bulletin. 1989; 25(1): 101-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2672066

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Downregulation of serotonin receptor subtypes by nortriptyline and adinazolam in major depressive disorder: neuroendocrine and platelet markers. Author(s): Stahl SM, Hauger RL, Rausch JL, Fleishaker JC, Hubbell-Alberts E. Source: Clinical Neuropharmacology. 1993; 16 Suppl 3: S19-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8131152

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Drug interaction between rifampin and nortriptyline: a case report. Author(s): Bebchuk JM, Stewart DE. Source: International Journal of Psychiatry in Medicine. 1991; 21(2): 183-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1894457

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EEG sleep measures in later-life bereavement depression. A randomized, doubleblind, placebo-controlled evaluation of nortriptyline. Author(s): Taylor MP, Reynolds CF 3rd, Frank E, Dew MA, Mazumdar S, Houck PR, Kupfer DJ. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 1999 Winter; 7(1): 41-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9919319

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Effect of clozapine on plasma nortriptyline concentration. Author(s): Smith T, Riskin J. Source: Pharmacopsychiatry. 1994 January; 27(1): 41-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8159782

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Effect of imipramine and nortriptyline on left ventricular function and blood pressure in patients treated for arrhythmias. Author(s): Giardina EG, Johnson LL, Vita J, Bigger JT Jr, Brem RF. Source: American Heart Journal. 1985 May; 109(5 Pt 1): 992-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3993532

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Effect of nortriptyline and paroxetine on CYP2D6 activity in depressed elderly patients. Author(s): Solai LK, Pollock BG, Mulsant BH, Frye RF, Miller MD, Sweet RA, Kirshner M, Sorisio D, Begley A, Reynolds CF 3rd. Source: Journal of Clinical Psychopharmacology. 2002 October; 22(5): 481-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12352271

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Effect of nortriptyline and paroxetine on extrapyramidal signs and symptoms: A prospective double-blind study in depressed elderly patients. Author(s): Mamo DC, Sweet RA, Mulsant BH, Pollock BG, Miller MD, Stack JA, Begley AE, Reynolds CF 3rd. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2000 Summer; 8(3): 226-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10910421

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Effect of nortriptyline on the day-night systolic blood pressure difference in hypertensive and normotensive elderly depressed women. Author(s): Scalco MZ, Serro-Azul JB, Giorgi D, Almeida OP, Wajngarten M. Source: The American Journal of Cardiology. 2003 May 15; 91(10): 1279-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12745123

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Effect of nortriptyline on yohimbine-induced changes in heart rate variability. Author(s): Yeragani VK. Source: Biological Psychiatry. 1996 March 1; 39(5): 385-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8704075

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Effect of sertraline on plasma nortriptyline levels in depressed elderly. Author(s): Solai LK, Mulsant BH, Pollock BG, Sweet RA, Rosen J, Yu K, Reynolds CF 3rd. Source: The Journal of Clinical Psychiatry. 1997 October; 58(10): 440-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9375595

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Effects of divalproex sodium on amitriptyline and nortriptyline pharmacokinetics. Author(s): Wong SL, Cavanaugh J, Shi H, Awni WM, Granneman GR. Source: Clinical Pharmacology and Therapeutics. 1996 July; 60(1): 48-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8689811

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Effects of nortriptyline and paroxetine on postural sway in depressed elderly patients. Author(s): Mamo DC, Pollock BG, Mulsant B, Houck PR, Bensasi S, Miller MC, Redfern MS, Reynolds III CF. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 March-April; 10(2): 199-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11925281

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Effects of nortriptyline and paroxetine on QT variability in patients with panic disorder. Author(s): Yeragani VK, Pohl R, Jampala VC, Balon R, Ramesh C, Srinivasan K. Source: Depression and Anxiety. 2000; 11(3): 126-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10875054

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Effects of nortriptyline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial. Author(s): Lustman PJ, Griffith LS, Clouse RE, Freedland KE, Eisen SA, Rubin EH, Carney RM, McGill JB. Source: Psychosomatic Medicine. 1997 May-June; 59(3): 241-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9178335

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Effects of nortriptyline on heart rate variability in panic disorder patients: a preliminary study using power spectral analysis of heart rate. Author(s): Yeragani VK, Srinivasan K, Pohl R, Berger R, Balon R, Ramesh C. Source: Neuropsychobiology. 1994; 29(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8127417

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Effects of smoking on nortriptyline plasma concentrations in depressed patients. Author(s): Perry PJ, Browne JL, Prince RA, Alexander B, Tsuang MT. Source: Therapeutic Drug Monitoring. 1986; 8(3): 279-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3750370

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Effects of the postpartum period on nortriptyline pharmacokinetics. Author(s): Wisner KL, Perel JM, Peindl KS, Findling RL, Hanusa BH. Source: Psychopharmacology Bulletin. 1997; 33(2): 243-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9230637

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Elevation of nortriptyline plasma levels after cotreatment with paroxetine and thioridazine. Author(s): Ghaemi SN, Kirkwood CK. Source: Journal of Clinical Psychopharmacology. 1998 August; 18(4): 342-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9690702

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Evaluation of platelet activation in depressed patients with ischemic heart disease after paroxetine or nortriptyline treatment. Author(s): Pollock BG, Laghrissi-Thode F, Wagner WR. Source: Journal of Clinical Psychopharmacology. 2000 April; 20(2): 137-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10770450

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Exacerbation of acute intermittent porphyria by nortriptyline. Author(s): Krummel SJ, Wesner RB. Source: Drug Intell Clin Pharm. 1986 June; 20(6): 487-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3720542

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Extrapyramidal symptoms associated with the adjunct of nortriptyline to a venlafaxine-valproic acid combination. Author(s): Conforti D, Borgherini G, Fiorellini Bernardis LA, Magni G. Source: International Clinical Psychopharmacology. 1999 May; 14(3): 197-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10435776

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Extreme values of the concentration/dose ratio as a risk factor of obtaining suboptimal nortriptyline serum concentrations. Author(s): Linnet K. Source: Therapeutic Drug Monitoring. 1996 February; 18(1): 53-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8848821

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Factors affecting the delay of antidepressant effect in responders to nortriptyline and phenelzine. Author(s): Georgotas A, McCue RE, Cooper TB, Nagachandran N, Friedhoff A. Source: Psychiatry Research. 1989 April; 28(1): 1-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2662234

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Factors influencing nortriptyline steady-state kinetics: plasma and saliva levels. Author(s): Kragh-Sorensen P, Larsen NE. Source: Clinical Pharmacology and Therapeutics. 1980 December; 28(6): 796-803. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7438694

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Fatal nortriptyline overdose, plasma levels, and in vivo methylation of tricyclic antidepressants. Author(s): Rudorfer MV, Robins E. Source: The American Journal of Psychiatry. 1981 July; 138(7): 982-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7258363

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First pass hydroxylation of nortriptyline: concentrations of parent drug and major metabolites in plasma. Author(s): Alvan G, Borga O, Lind M, Palmer L, Siwers B. Source: European Journal of Clinical Pharmacology. 1977 March 11; 11(3): 219-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=852498

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First-pass metabolism of nortriptyline in man. Author(s): Gram LF, Overo KF. Source: Clinical Pharmacology and Therapeutics. 1975 September; 18(3): 305-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1164819

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Fluconazole-nortriptyline drug interaction. Author(s): Gannon RH, Anderson ML. Source: The Annals of Pharmacotherapy. 1992 November; 26(11): 1456-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1477454

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Fluoxetine and nortriptyline combination therapy. Author(s): Schraml F, Benedetti G, Hoyle K, Clayton A. Source: The American Journal of Psychiatry. 1989 December; 146(12): 1636-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2589560

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Fluoxetine-nortriptyline therapy of treatment-resistant major depression in a geriatric patient. Author(s): Rothschild BS. Source: Journal of Geriatric Psychiatry and Neurology. 1994 July-September; 7(3): 137-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7916935

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Flupenthixol versus combined fluphenazine-nortriptyline in depressive illness. Author(s): Conway JF. Source: The Practitioner. 1981 March; 225(1353): 400-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7022433

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Fluphenazine/nortriptyline in the irritable bladder syndrome. A double-blind placebo controlled study. Author(s): Martin MR, Schiff AA. Source: British Journal of Urology. 1984 April; 56(2): 178-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6388713

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Food intake and the presystemic metabolism of single doses of amitriptyline and nortriptyline. Author(s): Liedholm H, Liden A. Source: Fundamental & Clinical Pharmacology. 1998; 12(6): 636-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9818297

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Gas chromatographic determination of amitriptyline, nortriptyline and perphenazine in plasma of schizophrenic patients after administration of the combination of amitriptyline with perphenazine. Author(s): Cooper S, Albert JM, Dugal R, Bertrand M, Elie R. Source: Arzneimittel-Forschung. 1979; 29(1): 158-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=582110

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Gas chromatography-mass spectrometry of nortriptyline in body fluids of man. Author(s): Hammar CG, Alexanderson B, Holmstedt B, Sjoqvist F. Source: Clinical Pharmacology and Therapeutics. 1971 May-June; 12(3): 496-505. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5571282

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Gas-chromatographic analysis for therapeutic concentrations of amitriptyline and nortriptyline in plasma, with use of a nitrogen detector. Author(s): Bailey DN, Jatlow PI. Source: Clinical Chemistry. 1976 June; 22(6): 777-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1277461

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Genetic control of drug levels and of the induction of drug-metabolizing enzymes in man: individual variability in the extent of allopurinol and nortriptyline inhibition of drug metabolism. Author(s): Vesell ES, Passananti GT, Greene FE, Page JG. Source: Annals of the New York Academy of Sciences. 1971 July 6; 179: 752-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4105797

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Genetic control of nortriptyline kinetics in man: a study of relatives of propositi with high plasma concentrations. Author(s): Asberg M, Evans DA, Sjoqvist F. Source: Journal of Medical Genetics. 1971 June; 8(2): 129-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5096533

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Genetic control of nortriptyline kinetics in man--a study of relatives of propositi with high plasma concentration. Author(s): Asberg M, Evans DA, Sjoqvist F. Source: Chemico-Biological Interactions. 1971 August; 3(4): 238-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5132988

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Glucuronidation of E-10-hydroxynortriptyline in human liver, kidney, and intestine. Organ-specific differences in enantioselectivity. Author(s): Dahl-Puustinen ML, Dumont E, Bertilsson L. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1989 JulyAugust; 17(4): 433-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2571485

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Glucuronidation of the enantiomers of E-10-hydroxynortriptyline in human and rat liver microsomes. Author(s): Dumont E, von Bahr C, Perry TL Jr, Bertilsson L. Source: Pharmacology & Toxicology. 1987 November; 61(5): 335-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3125532

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Heart failure associated with high plasma 10-hydroxynortriptyline levels. Author(s): Young RC, Alexopoulos GS, Shamoian CA, Dhar AK, Kutt H. Source: The American Journal of Psychiatry. 1984 March; 141(3): 432-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6703113

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Heuristic comparison of sertraline with nortriptyline for the treatment of depression in frail elderly patients. Author(s): Oslin DW, Streim JE, Katz IR, Smith BD, DiFilippo SD, Ten Have TR, Cooper T. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2000 Spring; 8(2): 141-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10804075

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High initial nortriptyline doses in the treatment of depression. Author(s): Warner MD, Griffin M, Peabody CA. Source: The Journal of Clinical Psychiatry. 1993 February; 54(2): 67-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8444823

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High plasma nortriptyline levels in the treatment of depression. I. Author(s): Montgomery S, Braithwaite R, Dawling S, McAuley R. Source: Clinical Pharmacology and Therapeutics. 1978 March; 23(3): 309-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=627137

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High-affinity stereoselective reduction of the enantiomers of ketotifen and of ketonic nortriptyline metabolites by aldo-keto reductases from human liver. Author(s): Breyer-Pfaff U, Nill K. Source: Biochemical Pharmacology. 2000 February 1; 59(3): 249-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10609553

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High-performance liquid chromatographic quantitation of amitriptyline and nortriptyline in dialysate from plasma or serum using on-line solid-phase extraction. Author(s): Svensson C, Nyberg G, Martensson E. Source: Journal of Chromatography. 1988 November 18; 432: 363-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3220906

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High-performance liquid chromatography-mass spectrometry for the quantification of nortriptyline and 10-hydroxynortriptyline in plasma. Author(s): Tybring G, Nordin J, Widen J. Source: J Chromatogr B Biomed Sci Appl. 1998 September 25; 716(1-2): 382-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9824256

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Hydroxylation and demethylation of the tricyclic antidepressant nortriptyline by cDNA-expressed human cytochrome P-450 isozymes. Author(s): Olesen OV, Linnet K. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1997 June; 25(6): 740-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9193876

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Identification of a major metabolite of nortriptyline in human urine. Author(s): De Leenheer A, Heyndrickx A. Source: Journal of Pharmaceutical Sciences. 1971 September; 60(9): 1403-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5567593

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Immunoassay reagents for psychoactive drugs. Part 4. Quantitative determination of amitriptyline and nortriptyline by fluorescence polarization immunoassay. Author(s): Adamczyk M, Fishpaugh JR, Harrington CA, Hartter DE, Vanderbilt AS, Orsulak P, Akers L. Source: Therapeutic Drug Monitoring. 1994 June; 16(3): 298-311. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8085284

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Impairment of drug metabolism in man by allopurinol and nortriptyline. Author(s): Vesell ES, Passananti GT, Greene FE. Source: The New England Journal of Medicine. 1970 December 31; 283(27): 1484-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4098480

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Implications of dose regimen and protein binding for plasma nortriptyline estimations. Author(s): Stevenson IH, Wilson NM, Schiff AA. Source: Neuropharmacology. 1978 June; 17(6): 423-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=673158

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Importance of evaporation conditions and two internal standards for quantitation of amitriptyline and nortriptyline. Author(s): Sonsalla PK, Jennison TA, Finkle BS. Source: Clinical Chemistry. 1982 June; 28(6): 1401-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7074956

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Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Author(s): Borson S, McDonald GJ, Gayle T, Deffebach M, Lakshminarayan S, VanTuinen C. Source: Psychosomatics. 1992 Spring; 33(2): 190-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1557484

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Increased plasma nortriptyline concentration in a patient cotreated with fluoxetine. Author(s): Kahn DG. Source: The Journal of Clinical Psychiatry. 1990 January; 51(1): 36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2295592

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Indoleamine metabolites in the cerebrospinal fluid of depressed patients before and during treatment with nortriptyline. Author(s): Asberg M, Bertilsson L, Tuck D, Cronholm B, Sjoqvist F. Source: Clinical Pharmacology and Therapeutics. 1973 March-April; 14(2): 277-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4695388

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Inhibition of 5-hydroxytryptamine and noradrenaline uptake in platelets and synaptosomes incubated in plasma from human subjects treated with amitryptyline or nortriptyline: utilization of the principle for a bioassay method. Author(s): Tuomisto J, Tukiainen E, Voutilainen R, Tuomainen P. Source: Psychopharmacology. 1980; 69(2): 137-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6779306

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Inhibition of cytochrome P4502D6 activity with paroxetine normalizes the ultrarapid metabolizer phenotype as measured by nortriptyline pharmacokinetics and the debrisoquin test. Author(s): Laine K, Tybring G, Hartter S, Andersson K, Svensson JO, Widen J, Bertilsson L. Source: Clinical Pharmacology and Therapeutics. 2001 October; 70(4): 327-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11673748

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Initial platelet serotonin (5-HT) transport kinetics predict nortriptyline treatment outcome. Author(s): Rausch JL, Moeller FG, Johnson ME. Source: Journal of Clinical Psychopharmacology. 2003 April; 23(2): 138-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640215

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Interaction between amitriptyline and phenothiazine in man: effect on plasma concentration of amitriptyline and its metabolite nortriptyline and the correlation with clinical response. Author(s): Vandel B, Vandel S, Allers G, Bechtel P, Volmat R. Source: Psychopharmacology. 1979 October; 65(2): 187-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=42101

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Interaction of chlorpromazine and nortriptyline in patients with schizophrenia. Author(s): Loga S, Curry S, Lader M. Source: Clinical Pharmacokinetics. 1981 November-December; 6(6): 454-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7318304

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Interaction of perphenazine with the kinetics of nortriptyline. Author(s): Overo KF, Gram LF, Hansen V. Source: Acta Pharmacol Toxicol (Copenh). 1977 January; 40(1): 97-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=576367

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Interlaboratory comparison of nortriptyline levels. Author(s): Burrows GD, Davies B, Maguire KP, Norman TR, Scoggins BA, Hullin RP, Burch J. Source: Biochem Med. 1978 August; 20(1): 125-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=363125

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Isomers of 10-hydroxynortriptyline in geriatric depression. Author(s): Young RC, Dhar AK, Kutt H, Alexopoulos GS. Source: Therapeutic Drug Monitoring. 1988; 10(2): 164-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3381232

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Kinetics of nortriptyline in man according to a two compartment model. Author(s): Overo KF, Gram LF, Hansen V. Source: European Journal of Clinical Pharmacology. 1975 June 13; 8(5): 343-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1233233

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Lack of correlation between plasma levels of amitriptyline (and nortriptyline) and clinical improvement of chronic pain of peripheral neurologic origin. Author(s): Rascol O, Tran MA, Bonnevialle P, Belin J, Cotonat J, Guiraud-Chaumeil B, Montastruc JL. Source: Clinical Neuropharmacology. 1987 December; 10(6): 560-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3427563

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Left bundle branch block developing in a patient with sub-therapeutic nortriptyline levels: a case report. Author(s): Gross JS, Zwerin G. Source: Journal of the American Geriatrics Society. 1991 October; 39(10): 1006-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1918772

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Letter: On activated charcoal and nortriptyline. Author(s): Chaput de Saintonge DM, Herxheimer A. Source: European Journal of Clinical Pharmacology. 1973 October; 6(3): 207. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4762060

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Lithium augmentation of nortriptyline for subjects resistant to multiple antidepressants. Author(s): Nierenberg AA, Papakostas GI, Petersen T, Montoya HD, Worthington JJ, Tedlow J, Alpert JE, Fava M. Source: Journal of Clinical Psychopharmacology. 2003 February; 23(1): 92-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544380

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Little anticholinergic effect of E-10-hydroxynortriptyline compared with nortriptyline in healthy subjects. Author(s): Nordin C, Bertilsson L, Otani K, Widmark A. Source: Clinical Pharmacology and Therapeutics. 1987 January; 41(1): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3802713

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Longitudinal analysis of nortriptyline side effects in elderly depressed patients. Author(s): Miller MD, Pollock BG, Rifai AH, Paradis CF, Perel JM, George C, Stack JA, Reynolds CF 3rd. Source: Journal of Geriatric Psychiatry and Neurology. 1991 October-December; 4(4): 226-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1789911

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Longitudinal effects of nortriptyline on EEG sleep and the likelihood of recurrence in elderly depressed patients. Author(s): Buysse DJ, Reynolds CF 3rd, Hoch CC, Houck PR, Kupfer DJ, Mazumdar S, Frank E. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1996 April; 14(4): 243-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8924192

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Long-term ECG changes in depressed elderly patients treated with nortriptyline. A double-blind, randomized, placebo-controlled evaluation. Author(s): Miller MD, Curtiss EI, Marino L, Houck PR, Paradis CF, Mazumdar S, Pollock BG, Foglia J, Reynolds CF 3rd. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 1998 Winter; 6(1): 59-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9469215

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Long-term treatment of endogenous depression with nortriptyline with control of plasma levels. Author(s): Kragh-Sorensen P, Hansen CE, Larsen NE, Nasestoft J, Hvidberg EF. Source: Psychological Medicine. 1974 May; 4(2): 174-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4208380

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Maintenance nortriptyline effects on electroencephalographic sleep in elderly patients with recurrent major depression: double-blind, placebo- and plasma-levelcontrolled evaluation. Author(s): Reynolds CF 3rd, Buysse DJ, Brunner DP, Begley AE, Dew MA, Hoch CC, Hall M, Houck PR, Mazumdar S, Perel JM, Kupfer DJ. Source: Biological Psychiatry. 1997 October 1; 42(7): 560-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9376452

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Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures. Author(s): Yeragani VK, Pesce V, Jayaraman A, Roose S. Source: Biological Psychiatry. 2002 September 1; 52(5): 418-29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12242058

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Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on measures of nonlinearity and chaos of heart rate. Author(s): Yeragani VK, Roose S, Mallavarapu M, Radhakrishna RK, Pesce V. Source: Neuropsychobiology. 2002; 46(3): 125-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12422059

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Maprotiline and fluphenazine/nortriptyline in depression. Author(s): O'Hara H, O'Hara J, Valle-Jones JC, McGhie RL, Brodie NH, Schiff AA. Source: The Practitioner. 1978 September; 221(1323): 419-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=366595

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Marked sinus tachycardia resulting from the synergistic effects of marijuana and nortriptyline. Author(s): Hillard JR, Vieweg WV. Source: The American Journal of Psychiatry. 1983 May; 140(5): 626-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6303138

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Measurement of plasma nortriptyline concentrations: radioimmunoassay and gaschromatography compared. Author(s): Robinson JD, Braithwaite RA, Dawling S. Source: Clinical Chemistry. 1978 November; 24(11): 2023-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=709839

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Metabolic and physiologic consequences of nortriptyline treatment in the elderly. Author(s): Pollock BG, Perel JM, Paradis CF, Fasiczka AL, Reynolds CF 3rd. Source: Psychopharmacology Bulletin. 1994; 30(2): 145-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7831447

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Metabolite intermediate complexation of microsomal cytochrome P450 2C11 in male rat liver by nortriptyline. Author(s): Murray M. Source: Molecular Pharmacology. 1992 November; 42(5): 931-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1435757

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Methylphenidate and nortriptyline in the treatment of poststroke depression: a retrospective comparison. Author(s): Lazarus LW, Moberg PJ, Langsley PR, Lingam VR. Source: Archives of Physical Medicine and Rehabilitation. 1994 April; 75(4): 403-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8172499

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Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and betweenbreast differences in two patients. Author(s): Matheson I, Skjaeraasen J. Source: European Journal of Clinical Pharmacology. 1988; 35(2): 217-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3191943

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Mixed anxiety/depressive illness in general practice. A therapeutic comparison of nomifensine with fluphenazine/nortriptyline. Author(s): Valle-Jones JC, Craven JR, Wallis TD, Schiff AA. Source: Acta Psychiatrica Scandinavica. 1983 December; 68(6): 494-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6666645

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Moclobemide and nortriptyline in elderly depressed patients. A randomized, multicentre trial against placebo. Author(s): Nair NP, Amin M, Holm P, Katona C, Klitgaard N, Ng Ying Kin NM, KraghSorensen P, Kuhn H, Leek CA, Stage KB. Source: Journal of Affective Disorders. 1995 January 11; 33(1): 1-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7714303

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Modification of hyperkinetic behavior by nortriptyline. Author(s): Watter N, Dreifuss FE. Source: Va Med Mon (1918). 1973 February; 100(2): 123-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4683948

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Monitoring nortriptyline plasma concentrations. Author(s): Hollister LE, Pfefferbaum A, Davis KL. Source: The American Journal of Psychiatry. 1980 April; 137(4): 485-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7361940

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Monitoring plasma concentration of nortriptyline. Methodological, pharmakokinetic and clinical aspects. Author(s): Kragh-Sorensen P. Source: Dan Med Bull. 1985 March; 32(1): 29-53. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3886309

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Neuroleptic malignant syndrome associated with nortriptyline. Author(s): June R, Yunus M, Gossman W. Source: The American Journal of Emergency Medicine. 1999 November; 17(7): 736-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10597103

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Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Author(s): Hall SM, Reus VI, Munoz RF, Sees KL, Humfleet G, Hartz DT, Frederick S, Triffleman E. Source: Archives of General Psychiatry. 1998 August; 55(8): 683-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9707377

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Nortriptyline and fluphenazine in the symptomatic treatment of diabetic neuropathy. A double-blind cross-over study. Author(s): Gomez-Perez FJ, Rull JA, Dies H, Rodriquez-Rivera JG, Gonzalez-Barranco J, Lozano-Castaneda O. Source: Pain. 1985 December; 23(4): 395-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3911140

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Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. Author(s): Reynolds CF 3rd, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S, Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ. Source: Jama : the Journal of the American Medical Association. 1999 January 6; 281(1): 39-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9892449

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Nortriptyline and neuropathic pain. Author(s): Cohen H, Cohen MR. Source: The Nurse Practitioner. 1999 April; 24(4): 124. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10234693

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Nortriptyline and protriptyline in hyperventilation. Author(s): DiFilippo NM. Source: Archives of Internal Medicine. 1985 September; 145(9): 1736. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4026507

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Nortriptyline E-10-hydroxylation in vitro is mediated by human CYP2D6 (high affinity) and CYP3A4 (low affinity): implications for interactions with enzymeinducing drugs. Author(s): Venkatakrishnan K, von Moltke LL, Greenblatt DJ. Source: Journal of Clinical Pharmacology. 1999 June; 39(6): 567-77. Erratum In: J Clin Pharmacol 1999 August; 39(8): 866. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10354960

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Nortriptyline for depression and vulvodynia. Author(s): Cochrane Database Syst Rev. 2003;(2):CD000031 Source: The American Journal of Psychiatry. 2002 February; 159(2): 316-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804385

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Nortriptyline for the treatment of depression in progressive supranuclear palsy. Author(s): Tamai S, Almeida OP. Source: Journal of the American Geriatrics Society. 1997 August; 45(8): 1033-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9256865

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Nortriptyline for treatment-resistant depression. Author(s): Nierenberg AA, Papakostas GI, Petersen T, Kelly KE, Iacoviello BM, Worthington JJ, Tedlow J, Alpert JE, Fava M. Source: The Journal of Clinical Psychiatry. 2003 January; 64(1): 35-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12590621

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Nortriptyline in geriatric depression resistant to serotonin reuptake inhibitors: case series. Author(s): Weintraub D. Source: Journal of Geriatric Psychiatry and Neurology. 2001 Spring; 14(1): 28-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11281313

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Nortriptyline in the treatment of a monosymptomatic delusion. Author(s): Pylko T, Sicignan J. Source: The American Journal of Psychiatry. 1985 October; 142(10): 1223. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4037137

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Nortriptyline intoxication induced by terbinafine. Author(s): van der Kuy PH, Hooymans PM. Source: Bmj (Clinical Research Ed.). 1998 February 7; 316(7129): 441. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9492672

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Nortriptyline kinetics in Hispanic and Anglo subjects. Author(s): Gaviria M, Gil AA, Javaid JI. Source: Journal of Clinical Psychopharmacology. 1986 August; 6(4): 227-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3734142

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Nortriptyline pharmacokinetics and plasma levels: implications for clinical practice. Author(s): Rubin EH, Biggs JT, Preskorn SH. Source: The Journal of Clinical Psychiatry. 1985 October; 46(10): 418-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3900052

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Nortriptyline pulse loading in depressed patients. Author(s): Deuschle M, Weber B, Standhardt H, Lammers CH, Hartmann A, Heuser I. Source: Journal of Clinical Psychopharmacology. 1998 February; 18(1): 96-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9472856

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Nortriptyline toxicity secondary to interaction with bupropion sustained-release. Author(s): Weintraub D. Source: Depression and Anxiety. 2001; 13(1): 50-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11233461

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Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Author(s): Watson CP, Vernich L, Chipman M, Reed K. Source: Neurology. 1998 October; 51(4): 1166-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9781549

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Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: a placebo-controlled, double-blind study. Author(s): Robinson RG, Schultz SK, Castillo C, Kopel T, Kosier JT, Newman RM, Curdue K, Petracca G, Starkstein SE. Source: The American Journal of Psychiatry. 2000 March; 157(3): 351-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10698809

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Nortriptyline-induced severe hyperventilation. Author(s): Sunderrajan S, Brooks CS, Sunderrajan EV. Source: Archives of Internal Medicine. 1985 April; 145(4): 746-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3985739

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On the relationship between free plasma and saliva amitriptyline and nortriptyline. Author(s): Baumann P, Tinguely D, Koeb L, Schopf J, Le PK. Source: Int Pharmacopsychiatry. 1982; 17(3): 136-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7141811

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On the relationship of nortriptyline: amitriptyline ratio to clinical improvement of amitriptyline treated depressive patients. Author(s): Jungkunz G, Kuss HJ. Source: Pharmakopsychiatr Neuropsychopharmakol. 1980 May; 13(3): 111-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7393997

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Once daily administration of a fluphenazine/nortriptyline preparation in the treatment of mixed anxiety/depressive states. Author(s): Brodie NH, McGhie RL, O'Hara H, O'Hara J, Rodway AE, Valle-Jones JC, Schiff AA. Source: Current Medical Research and Opinion. 1976; 4(5): 346-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=795608

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Once-daily treatment for mixed anxiety/depressive states: a comparison of slow release amitriptyline and fluphenazine with nortriptyline. Author(s): Magnus RV, Schiff AA. Source: J Int Med Res. 1977; 5(2): 109-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=873028

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On-line solid-phase extraction and high-performance liquid chromatographic determination of nortriptyline and amitriptyline in serum. Author(s): Dolezalova M. Source: Journal of Chromatography. 1992 September 2; 579(2): 291-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1429976

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Open-trial maintenance nortriptyline in geriatric depression: survival analysis and preliminary data on the use of REM latency as a predictor of recurrence. Author(s): Reynolds CF 3rd, Perel JM, Frank E, Imber S, Kupfer DJ. Source: Psychopharmacology Bulletin. 1989; 25(1): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2772111

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Ophthalmological effects of nortriptyline--relationship to plasma level. Author(s): Asberg M, Germanis M. Source: Pharmacology. 1972; 7(5): 349-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4566251

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Optimal sampling times for Bayesian estimation of the pharmacokinetic parameters of nortriptyline during therapeutic drug monitoring. Author(s): Merle Y, Mentre F. Source: Journal of Pharmacokinetics and Biopharmaceutics. 1999 February; 27(1): 85-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10533699

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Organ levels of amitriptyline and nortriptyline in fatal amitriptyline poisoning. Author(s): Kristinsson J, Johannesson T, Bjarnason O, Geirsson G. Source: Acta Pharmacol Toxicol (Copenh). 1983 February; 52(2): 150-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6846023

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Ototoxic reaction associated with use of nortriptyline hydrochloride: case report. Author(s): Smith EE, Reece CA, Kauffman R. Source: The Journal of Pediatrics. 1972 June; 80(6): 1046-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5026029

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Paroxetine versus nortriptyline in the continuation and maintenance treatment of depression in the elderly. Author(s): Bump GM, Mulsant BH, Pollock BG, Mazumdar S, Begley AE, Dew MA, Reynolds CF 3rd. Source: Depression and Anxiety. 2001; 13(1): 38-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11233459

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Patterns and predictors of remission, response and recovery in major depression treated with fluoxetine or nortriptyline. Author(s): Joyce PR, Mulder RT, Luty SE, Sullivan PF, McKenzie JM, Abbott RM, Stevens IF. Source: The Australian and New Zealand Journal of Psychiatry. 2002 June; 36(3): 384-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12060188

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Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine. Author(s): Nebes RD, Pollock BG, Houck PR, Butters MA, Mulsant BH, Zmuda MD, Reynolds CF 3rd. Source: Journal of Psychiatric Research. 2003 March-April; 37(2): 99-108. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12842163

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Pharmacokinetic interaction between diltiazem and nortriptyline. Author(s): Krahenbuhl S, Smith-Gamble V, Hoppel CL. Source: European Journal of Clinical Pharmacology. 1996; 49(5): 417-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8866640

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Pharmacokinetic interaction between nortriptyline and terbinafine. Author(s): Van Der Kuy PH, Van Den Heuvel HA, Kempen RW, Vanmolkot LM. Source: The Annals of Pharmacotherapy. 2002 November; 36(11): 1712-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12398564

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Pharmacokinetically designed double-blind placebo-controlled study of nortriptyline in 6- to 12-year-olds with major depressive disorder. Author(s): Geller B, Cooper TB, Graham DL, Fetner HH, Marsteller FA, Wells JM. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1992 January; 31(1): 34-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1537779

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Pharmacokinetics of nortriptyline and its 10-hydroxy metabolite in Chinese subjects of different CYP2D6 genotypes. Author(s): Yue QY, Zhong ZH, Tybring G, Dalen P, Dahl ML, Bertilsson L, Sjoqvist F. Source: Clinical Pharmacology and Therapeutics. 1998 October; 64(4): 384-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9797795

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Phase III evaluation of nortriptyline for alleviation of symptoms of cis-platinuminduced peripheral neuropathy. Author(s): Hammack JE, Michalak JC, Loprinzi CL, Sloan JA, Novotny PJ, Soori GS, Tirona MT, Rowland KM Jr, Stella PJ, Johnson JA. Source: Pain. 2002 July; 98(1-2): 195-203. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12098632

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Plasma 10-hydroxynortriptyline and ECG changes in elderly depressed patients. Author(s): Young RC, Alexopoulos GS, Shamoian CA, Kent E, Dhar AK, Kutt H. Source: The American Journal of Psychiatry. 1985 July; 142(7): 866-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4014510

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Plasma 10-hydroxynortriptyline and renal function in elderly depressives. Author(s): Young RC, Alexopoulos GS, Dhar AK, Kutt H. Source: Biological Psychiatry. 1987 October; 22(10): 1283-7. Erratum In: Biol Psychiatry 1988 March 15; 23(6): 650. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3663780

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Plasma and salivary nortriptyline concentrations in a patient with black tongue. Author(s): Vitiello B, Yeung J, Friedman E. Source: Clin Pharm. 1990 June; 9(6): 421-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2364649

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Plasma concentrations of nortriptyline and its 10-hydroxy metabolite in depressed patients--relationship to the debrisoquine hydroxylation metabolic ratio. Author(s): Nordin C, Siwers B, Benitez J, Bertilsson L. Source: British Journal of Clinical Pharmacology. 1985 June; 19(6): 832-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4027124

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Plasma levels of nortriptyline and 10-hydroxynortriptyline and treatment-related electrocardiographic changes in the elderly depressed. Author(s): McCue RE, Georgotas A, Nagachandran N, Abdul Basir M, Go EA, Suckow RF, Cooper TB. Source: Journal of Psychiatric Research. 1989; 23(1): 73-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2754630

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Plasma tyrosine/neutral amino acid ratio correlated with clinical response to nortriptyline in endogenously depressed patients. Author(s): Moller SE, Odum K, Kirk L, Bjerre M, Fog-Moller F, Knudsen A. Source: Journal of Affective Disorders. 1985 November; 9(3): 223-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2934455

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Possible serotonin syndrome arising from an interaction between nortriptyline and selegiline in a lady with parkinsonism. Author(s): Hinds NP, Hillier CE, Wiles CM. Source: Journal of Neurology. 2000 October; 247(10): 811. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11127542

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Precaution with titrating nortriptyline after the use of fluoxetine. Author(s): Skowron DM, Gutierrez MA, Epstein S. Source: Dicp. 1990 October; 24(10): 1008. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2244395

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Prediction of individual dosage of nortriptyline in depressed elderly outpatients. Author(s): Schneider LS, Cooper TB, Staples FR, Sloane RB. Source: Journal of Clinical Psychopharmacology. 1987 October; 7(5): 311-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3680600

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Preliminary data on the relationship between nortriptyline plasma level and response in depressed children. Author(s): Geller B, Cooper TB, Chestnut EC, Anker JA, Schluchter MD. Source: The American Journal of Psychiatry. 1986 October; 143(10): 1283-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3532829

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Pretreatment orthostatic hypotension as a predictor of response to nortriptyline in geriatric depression. Author(s): Schneider LS, Sloane RB, Staples FR, Bender M. Source: Journal of Clinical Psychopharmacology. 1986 June; 6(3): 172-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3711368

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Psychiatric comorbidity as a predictor of clinical response to nortriptyline in treatment-resistant major depressive disorder. Author(s): Papakostas GI, Petersen TJ, Farabaugh AH, Murakami JL, Pava JA, Alpert JE, Fava M, Nierenberg AA. Source: The Journal of Clinical Psychiatry. 2003 November; 64(11): 1357-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14658951

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Quality control of amitriptyline and nortriptyline plasma level assessments: a multicenter study. Author(s): Baumann P, Breyer-Pfaff U, Kuss HJ, Muller-Oerlinghausen B, Sandoz M. Source: Pharmacopsychiatria. 1982 September; 15(5): 156-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7178230

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Quantification of amitriptyline, nortriptyline, and 10-hydroxy metabolite isomers in plasma by capillary gas chromatography with nitrogen-sensitive detection. Author(s): Jones DR, Lukey BJ, Hurst HE. Source: Journal of Chromatography. 1983 December 9; 278(2): 291-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6668310

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Quantitation of amitriptyline and nortriptyline in human serum. Author(s): Connor JN, Johnson GF, Solomon HM. Source: Journal of Chromatography. 1977 July 1; 143(4): 415-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=885981

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Quantitative analysis of amitriptyline and nortriptyline in human plasma and liver microsomal preparations by high-performance liquid chromatography. Author(s): Ghahramani P, Lennard MS. Source: Journal of Chromatography. B, Biomedical Applications. 1996 October 25; 685(2): 307-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8953172

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Quantitative determination of amitriptyline and its principal metabolite, nortriptyline, by GLC-chemical ionization mass spectrometry. Author(s): Garland WA. Source: Journal of Pharmaceutical Sciences. 1977 January; 66(1): 77-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=833746

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Quantitative determination of amitriptyline and nortriptyline in plasma by highperformance liquid chromatography. Author(s): Watson ID, Stewart MJ. Source: Journal of Chromatography. 1977 February 1; 132(1): 155-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=833225

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Quantitative homogeneous enzyme immunoassays for amitriptyline, nortriptyline, imipramine, and desipramine. Author(s): Pankey S, Collins C, Jaklitsch A, Izutsu A, Hu M, Pirio M, Singh P. Source: Clinical Chemistry. 1986 May; 32(5): 768-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3516450

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Quantitative pharmacogenetics of nortriptyline: a novel approach. Author(s): Kvist EE, Al-Shurbaji A, Dahl ML, Nordin C, Alvan G, Stahle L. Source: Clinical Pharmacokinetics. 2001; 40(11): 869-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11735606

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Quetiapine and falsely elevated nortriptyline level. Author(s): Schussler JM, Juenke JM, Schussler I. Source: The American Journal of Psychiatry. 2003 March; 160(3): 589. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12611850

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Radiochemical GLC assay for nortriptyline in human plasma. Author(s): Loh A, Zuleski FR, Di Carlo FJ. Source: Journal of Pharmaceutical Sciences. 1977 July; 66(7): 1056-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=886448

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Radioimmunoassay for nortriptyline and amitriptyline. Author(s): Aherne GW, Marks V, Mould G, Stout G. Source: Lancet. 1977 June 4; 1(8023): 1214. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=68320

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Radioimmunoassay for nortriptyline and amitryptyline. Author(s): Turner P. Source: Lancet. 1977 June 18; 1(8025): 1316. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=68419

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Radioimmunoassay of amitriptyline and nortriptyline in body fluids. Author(s): Mould GP, Stout G, Aherne GW, Marks V. Source: Annals of Clinical Biochemistry. 1978 July; 15(4): 221-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=567954

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Rapid radioisotopic procedure for determination of nortriptyline in plasma. Author(s): Maguire KP, Burrows GD, Coghlan JP, Scoggins BA. Source: Clinical Chemistry. 1976 June; 22(6): 761-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1277457

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Rapid response of patients simultaneously treated with lithium and nortriptyline. Author(s): Austin LS, Arana GW, Ballenger JC. Source: The Journal of Clinical Psychiatry. 1990 March; 51(3): 124-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2407731

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Rapid, sensitive gas-liquid chromatographic method for determination of amitryptyline and nortriptyline in plasma using a nitrogen-sensitive detector. Author(s): Hucker HB, Stauffer SC. Source: Journal of Chromatography. 1977 August 11; 138(2): 437-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=893605

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Recurrent hypotension immediately after seizures in nortriptyline overdose. Author(s): Lipper B, Bell A, Gaynor B. Source: The American Journal of Emergency Medicine. 1994 July; 12(4): 452-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8031432

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Regioselectivity and substrate concentration-dependency of involvement of the CYP2D subfamily in oxidative metabolism of amitriptyline and nortriptyline in rat liver microsomes. Author(s): Masubuchi Y, Iwasa T, Fujita S, Suzuki T, Horie T, Narimatsu S. Source: The Journal of Pharmacy and Pharmacology. 1996 September; 48(9): 925-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9036183

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Relationship between antidepressant effect and plasma level of nortriptyline. Clinical studies. Author(s): Kragh-Soorensen P, Hansen CE, Baastrup PC. Source: Pharmakopsychiatr Neuropsychopharmakol. 1976 January; 9(1): 27-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=790409

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Relationship between plasma level and therapeutic effect of nortriptyline. Author(s): Asberg M, Cronholm B, Sjoqvist F, Tuck D. Source: British Medical Journal. 1971 August 7; 3(770): 331-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5558186

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Relationship of free nortriptyline levels to therapeutic response. Author(s): Perry PJ, Browne JL, Alexander B, Pfohl BM, Dunner FJ, Sherman AD, Tsuang MT. Source: Acta Psychiatrica Scandinavica. 1985 August; 72(2): 120-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4050504

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Relationship of hydroxynortriptyline to nortriptyline concentration and creatinine clearance in depressed elderly outpatients. Author(s): Schneider LS, Cooper TB, Suckow RF, Lyness SA, Haugen C, Palmer R, Sloane RB. Source: Journal of Clinical Psychopharmacology. 1990 October; 10(5): 333-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2258449

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Relationships among nortriptyline, 10-OH(E)nortriptyline, and 10-OH(Z)nortriptyline steady-state plasma levels and nortriptyline dosage. Author(s): Lukey BJ, Jones DR, Wright JH, Hurst HE. Source: Therapeutic Drug Monitoring. 1989; 11(3): 221-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2728080

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Reliable routine method for the determination of plasma amitriptyline and nortriptyline by gas chromatography. Author(s): Burch JE, Raddats MA, Thompson SG. Source: Journal of Chromatography. 1979 March 1; 162(3): 351-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=528600

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Response of depressive symptoms to nortriptyline, phenelzine and placebo. Author(s): Georgotas A, McCue RE, Friedman E, Cooper TB. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1987 July; 151: 102-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3676606

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Reversal of learned helplessness by nortriptyline. Author(s): Telner JI, Singhal RL, Lapierre YD. Source: Prog Neuropsychopharmacol. 1981; 5(5-6): 587-90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7200250

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Routine nortriptyline levels in treatment of depression. Author(s): Montgomery SA, Braithwaite RA, Crammer JL. Source: British Medical Journal. 1977 July 16; 2(6080): 166-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=871827

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Safety of clonidine and nortriptyline. Author(s): Chapman NA. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1994 January; 33(1): 142-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8138513

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Selective determination of amitriptyline and nortriptyline in human plasma by HPLC with ultraviolet and particle beam mass spectrometry. Author(s): Kudo K, Jitsufuchi N, Imamura T. Source: Journal of Analytical Toxicology. 1997 May-June; 21(3): 185-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9171200

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Selective effect of nortriptyline on smooth muscle as an anticholinergic drug: a pharmacological and clinical study. Author(s): Nissenkorn I, Katz A, Rubinstein R, Cohen S. Source: European Urology. 1986; 12(2): 109-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3956544

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Serial ECG measurements at controlled plasma levels of nortriptyline in depressed children. Author(s): Geller B, Farooki ZQ, Cooper TB, Chestnut EC, Abel AS. Source: The American Journal of Psychiatry. 1985 September; 142(9): 1095-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4025630

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Serial monitoring and achievement of steady state nortriptyline plasma levels in depressed children and adolescents: preliminary data. Author(s): Geller B, Cooper TB, Chestnut EC. Source: Journal of Clinical Psychopharmacology. 1985 August; 5(4): 213-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4019809

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Serum anticholinergicity in elderly depressed patients treated with paroxetine or nortriptyline. Author(s): Pollock BG, Mulsant BH, Nebes R, Kirshner MA, Begley AE, Mazumdar S, Reynolds CF 3rd. Source: The American Journal of Psychiatry. 1998 August; 155(8): 1110-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9699704

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Sex-related differences in nortriptyline-induced side-effects among depressed patients. Author(s): Pomara N, Shao B, Choi SJ, Tun H, Suckow RF. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2001 July; 25(5): 1035-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11444676

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Simultaneous determination of amitriptyline, nortriptyline and four hydroxylated metabolites in serum by capillary gas-liquid chromatography with nitrogenphosphorus-selective detection. Author(s): Ulrich S, Isensee T, Pester U. Source: Journal of Chromatography. B, Biomedical Applications. 1996 October 11; 685(1): 81-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8930756

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Single-blind comparison of venlafaxine and nortriptyline in elderly major depression. Author(s): Gasto C, Navarro V, Marcos T, Portella MJ, Torra M, Rodamilans M. Source: Journal of Clinical Psychopharmacology. 2003 February; 23(1): 21-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544371

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Sleep deprivation accelerates the response to nortriptyline. Author(s): Shelton RC, Loosen PT. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1993 January; 17(1): 113-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8416598

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Sleep in bereavement-related depression during and after pharmacotherapy with nortriptyline. Author(s): Pasternak RE, Reynolds CF 3rd, Houck PR, Schlernitzauer M, Buysse DJ, Hoch CC, Kupfer DJ. Source: Journal of Geriatric Psychiatry and Neurology. 1994 April-June; 7(2): 69-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8204191

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Steady-state plasma levels of nortriptyline and its 10-hydroxy metabolite: relationship to the CYP2D6 genotype. Author(s): Dahl ML, Bertilsson L, Nordin C. Source: Psychopharmacology. 1996 February; 123(4): 315-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8867869

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Steady-state plasma levels of nortriptyline and its hydroxylated metabolites in Japanese patients: impact of CYP2D6 genotype on the hydroxylation of nortriptyline. Author(s): Morita S, Shimoda K, Someya T, Yoshimura Y, Kamijima K, Kato N. Source: Journal of Clinical Psychopharmacology. 2000 April; 20(2): 141-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10770451

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Stereoselective high-affinity reduction of ketonic nortriptyline metabolites and of ketotifen by aldo-keto reductases from human liver. Author(s): Breyer-Pfaff U, Nill K. Source: Advances in Experimental Medicine and Biology. 1999; 463: 473-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10352721

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Stereoselective inhibition of nortriptyline hydroxylation in man by quinidine. Author(s): Pfandl B, Morike K, Winne D, Schareck W, Breyer-Pfaff U. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1992 June; 22(6): 721-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1441595

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Stereoselective reversible ketone formation from 10-hydroxylated nortriptyline metabolites in human liver. Author(s): Breyer-Pfaff U, Nill K. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1995 December; 25(12): 1311-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8719907

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Stereoselectivity in bioequivalence studies of nortriptyline. Author(s): Midha KK, Hubbard JW, McKay G, Rawson M, Schwede R. Source: Journal of Pharmaceutical Sciences. 1995 October; 84(10): 1265-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8801346

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Stopping smoking: a prospective, randomized, double-blind study comparing nortriptyline to placebo. Author(s): da Costa CL, Younes RN, Lourenco MT. Source: Chest. 2002 August; 122(2): 403-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12171809

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Success rates for nortriptyline. Author(s): Jimenez-Ruiz C, De Granda Orive JI. Source: Chest. 2003 August; 124(2): 768-9; Author Reply 769. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12907576

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Successful treatment of interferon-alpha-induced mood disorder with nortriptyline. Author(s): Valentine AD, Meyers CA. Source: Psychosomatics. 1995 July-August; 36(4): 418-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7652148

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The antiarrhythmic effect of nortriptyline in cardiac patients with ventricular premature depolarizations. Author(s): Giardina EG, Barnard T, Johnson L, Saroff AL, Bigger JT Jr, Louie M. Source: Journal of the American College of Cardiology. 1986 June; 7(6): 1363-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3711494

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The cardiovascular effects of bupropion and nortriptyline in depressed outpatients. Author(s): Kiev A, Masco HL, Wenger TL, Johnston JA, Batey SR, Holloman LC. Source: Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists. 1994 June; 6(2): 107-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7804386

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The dexamethasone suppression test and treatment outcome in elderly depressed patients participating in a placebo-controlled multicenter trial involving moclobemide and nortriptyline. Author(s): Kin NM, Nair NP, Amin M, Schwartz G, Ahmed SK, Holm P, Katona C, Kragh-Sorensen P, Klitgaard N, Song WY, West TE, Stage K. Source: Biological Psychiatry. 1997 November 15; 42(10): 925-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9359979

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The effect of nortriptyline in elderly patients with cardiac conduction disease. Author(s): Dietch JT, Fine M. Source: The Journal of Clinical Psychiatry. 1990 February; 51(2): 65-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2298706

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The effects of fluoxetine versus nortriptyline on body weight in depression. Author(s): Gendall KA, Joyce PR, Mulder RT, Sullivan PF. Source: Journal of Clinical Psychopharmacology. 2000 December; 20(6): 714-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11106154

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The effects of nortriptyline on cognition in elderly depressed patients. Author(s): Hoff AL, Shukla S, Helms P, Aronson TA, Logue C, Ollo C, Cook B. Source: Journal of Clinical Psychopharmacology. 1990 June; 10(3): 231-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2376622

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The effects of perphenazine on the concentration of nortriptyline and its hydroxymetabolites in older patients. Author(s): Mulsant BH, Foglia JP, Sweet RA, Rosen J, Lo KH, Pollock BG. Source: Journal of Clinical Psychopharmacology. 1997 August; 17(4): 318-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9241013

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The use of therapeutic drug monitoring data to document kinetic drug interactions: an example with amitriptyline and nortriptyline. Author(s): Jerling M, Bertilsson L, Sjoqvist F. Source: Therapeutic Drug Monitoring. 1994 February; 16(1): 1-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7909176

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Three-year outcomes of maintenance nortriptyline treatment in late-life depression: a study of two fixed plasma levels. Author(s): Reynolds CF 3rd, Perel JM, Frank E, Cornes C, Miller MD, Houck PR, Mazumdar S, Stack JA, Pollock BG, Dew MA, Kupfer DJ. Source: The American Journal of Psychiatry. 1999 August; 156(8): 1177-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10450257

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Time course of enzyme induction in humans: effect of pentobarbital on nortriptyline metabolism. Author(s): von Bahr C, Steiner E, Koike Y, Gabrielsson J. Source: Clinical Pharmacology and Therapeutics. 1998 July; 64(1): 18-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9695715

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Toxicokinetics of nortriptyline and amitriptyline: two case reports. Author(s): Franssen EJ, Kunst PW, Bet PM, Strack van Schijndel RJ, van Loenen AC, Wilhelm AJ. Source: Therapeutic Drug Monitoring. 2003 April; 25(2): 248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12657923

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Transplacental transfer of amitriptyline and nortriptyline in isolated perfused human placenta. Author(s): Heikkinen T, Ekblad U, Laine K. Source: Psychopharmacology. 2001 February; 153(4): 450-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11243492

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Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Author(s): Reynolds CF 3rd, Miller MD, Pasternak RE, Frank E, Perel JM, Cornes C, Houck PR, Mazumdar S, Dew MA, Kupfer DJ. Source: The American Journal of Psychiatry. 1999 February; 156(2): 202-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9989555

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Treatment of depressed tinnitus patients with nortriptyline. Author(s): Sullivan MD, Dobie RA, Sakai CS, Katon WJ. Source: The Annals of Otology, Rhinology, and Laryngology. 1989 November; 98(11): 867-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2817678

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Treatment of depression with E-10-hydroxynortriptyline--a pilot study on biochemical effects and pharmacokinetics. Author(s): Nordin C, Bertilsson L, Dahl ML, Resul B, Toresson G, Sjoqvist F. Source: Psychopharmacology. 1991; 103(3): 287-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2057534

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Treatment of major depression with nortriptyline and paroxetine in patients with ischemic heart disease. Author(s): Nelson JC, Kennedy JS, Pollock BG, Laghrissi-Thode F, Narayan M, Nobler MS, Robin DW, Gergel I, McCafferty J, Roose S. Source: The American Journal of Psychiatry. 1999 July; 156(7): 1024-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10401446

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Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol. Author(s): Rosen J, Pollock BG, Altieri LP, Jonas EA. Source: The American Journal of Psychiatry. 1993 August; 150(8): 1249-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8101048

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Treatment of poststroke generalized anxiety disorder comorbid with poststroke depression: merged analysis of nortriptyline trials. Author(s): Kimura M, Tateno A, Robinson RG. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 May-June; 11(3): 320-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12724111

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Treatment of premenstrual depression with nortriptyline: a pilot study. Author(s): Harrison WM, Endicott J, Nee J. Source: The Journal of Clinical Psychiatry. 1989 April; 50(4): 136-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2647713

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Two prospective dosing methods for nortriptyline. Author(s): Perry PJ, Browne JL, Alexander B, Tsuang MT, Sherman AD, Dunner FJ. Source: Clinical Pharmacokinetics. 1984 November-December; 9(6): 555-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6509862

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Urinary retention in a neonate secondary to maternal ingestion of nortriptyline. Author(s): Shearer WT, Schreiner RL, Marshall RE. Source: The Journal of Pediatrics. 1972 September; 81(3): 570-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5049831

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Use of nortriptyline in adolescent-onset bipolar disorder. Author(s): Gilbert-Johnson AM, Constantino JN. Source: Journal of Child and Adolescent Psychopharmacology. 2002 Winter; 12(4): 363-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12625998

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Use of yohimbine to counteract nortriptyline-induced orthostatic hypotension. Author(s): Seibyl JP, Krystal JH, Price LH, Charney DS. Source: Journal of Clinical Psychopharmacology. 1989 February; 9(1): 67-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2708559

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Valproate/nortriptyline interaction. Author(s): Fu C, Katzman M, Goldbloom DS. Source: Journal of Clinical Psychopharmacology. 1994 June; 14(3): 205-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8027418

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Valpromide increases the plasma concentrations of amitriptyline and its metabolite nortriptyline in depressive patients. Author(s): Vandel S, Bertschy G, Jounet JM, Allers G. Source: Therapeutic Drug Monitoring. 1988; 10(4): 386-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3144066

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Value of serum tricyclic antidepressant levels with massive nortriptyline overdose and persistent hypotension. Author(s): Lipper B, Gaynor BD. Source: The American Journal of Emergency Medicine. 1995 January; 13(1): 107. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7832932

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Venlafaxine-fluoxetine-nortriptyline interaction. Author(s): Benazzi F. Source: Journal of Psychiatry & Neuroscience : Jpn. 1997 July; 22(4): 278-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9262050

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Verbal memory and plasma drug concentrations in elderly depressives treated with nortriptyline. Author(s): Young RC, Mattis S, Alexopoulos GS, Meyers BS, Shindledecker RD, Dhar AK. Source: Psychopharmacology Bulletin. 1991; 27(3): 291-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1775601

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CHAPTER 2. NUTRITION AND NORTRIPTYLINE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and nortriptyline.

Finding Nutrition Studies on Nortriptyline The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “nortriptyline” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “nortriptyline” (or a synonym): •

Desipramine and nortriptyline antagonize apomorphine and reserpine hypothermia by a different mechanism. Author(s): A. Menarini Farmaceutici s.r.l., Pharmacological Research Division, Florence, Italy. Source: Volterra, G Borsini, F Lecci, A Meli, A J-Pharm-Pharmacol. 1990 August; 42(8): 586-9 0022-3573

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Effects of oral administration of nortriptyline, imipramine and citalopram on morphine hot-plate and tail-immersion analgesia in rats. Source: Ibba, M Schiavi, S Abbiati, G Testa, R Boll-Chim-Farm. 1987 February; 126(2): 7580 0006-6648

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Enantioselective hydroxylation of nortriptyline in human liver microsomes, intestinal homogenate, and patients treated with nortriptyline. Author(s): Department of Clinical Pharmacology, Karolinska Institute, Huddinge Hospital, Sweden. Source: Dahl, M L Nordin, C Bertilsson, L Ther-Drug-Monit. 1991 May; 13(3): 189-94 0163-4356

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Studies on active transport of (E)-10-hydroxynortriptyline in the kidney and brain of rats: effects of propranolol and quinidine. Author(s): Department of Neuropsychiatry, Hirosaki University Hospital, Japan. Source: Otani, K Kaneko, S Bertilsson, L Pharmacol-Toxicol. 1991 May; 68(5): 380-3 09019928

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The pupil response to E-10-hydroxynortriptyline in rabbits with ocular sympathetic paresis. Author(s): Mount Sinai School of Medicine, Department of Ophthalmology, New York, NY 10029. Source: Mindel, J S Rubin, M A Kharlamb, A B J-Auton-Nerv-Syst. 1990 June; 30(2): 1757 0165-1838

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to nortriptyline; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Pyridoxine Alternative names: Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.drkoop.com Riboflavin Alternative names: Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.drkoop.com Thiamine Alternative names: Vitamin B1 (Thiamine) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B1 (Thiamine) Alternative names: Thiamine Source: Integrative Medicine Communications; www.drkoop.com

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Vitamin B2 (Riboflavin) Alternative names: Riboflavin Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 (Pyridoxine) Alternative names: Pyridoxine Source: Integrative Medicine Communications; www.drkoop.com

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CHAPTER 3. CLINICAL TRIALS AND NORTRIPTYLINE Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning nortriptyline.

Recent Trials on Nortriptyline The following is a list of recent trials dedicated to nortriptyline.5 Further information on a trial is available at the Web site indicated. •

Combined Nortriptyline and Transdermal Nicotine for Smoking Cessation Condition(s): Smoking Study Status: This study is no longer recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service Purpose - Excerpt: Treatment of smokers with a tricyclic antidepressant, nortriptyline, can reduce tobacco withdrawal symptoms and increases long term cessation rates when combined with transdermal nicotine and a behavioral cessation programs. The study is a placebo-controlled, randomized, parallel group trial in which smokers aged 18-70 will be subject to the combination of oral and patch treatments. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00018148

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Phase III Randomized Controlled Study of Morphine and Nortriptyline in the Management of Postherpetic Neuralgia Condition(s): Pain; Herpes Zoster Study Status: This study is completed.

5

These are listed at www.ClinicalTrials.gov.

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Sponsor(s): National Center for Research Resources (NCRR); National Institute of Neurological Disorders and Stroke (NINDS); Johns Hopkins University Purpose - Excerpt: Objectives: I. Determine whether opioid (morphine) treatment results in better management of pain than treatment with tricyclic antidepressant (nortriptyline). II. Assess the effects the two treatments have on affective and cognitive functions. III. Determine whether the presence of psychiatric comorbidity, particularly depression, can predict the outcome of the two treatments. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004390

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “nortriptyline” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 4. PERIODICALS AND NEWS ON NORTRIPTYLINE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover nortriptyline.

News Services and Press Releases One of the simplest ways of tracking press releases on nortriptyline is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “nortriptyline” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to nortriptyline. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “nortriptyline” (or synonyms). The following was recently listed in this archive for nortriptyline: •

Nortriptyline increases cessation rates in chronic smokers Source: Reuters Industry Breifing Date: August 26, 2002

•

FDA approves Pharmaceutical Associates' generic version of Novartis' Pamelor Source: Reuters Industry Breifing Date: August 28, 2000

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FDA clears Taro's nortriptyline hydrochloride capsules Source: Reuters Industry Breifing Date: May 16, 2000

•

Sertraline, nortriptyline similarly effective in treating depression in the elderly Source: Reuters Medical News Date: May 08, 2000

•

Nortriptyline plus psychotherapy prevents recurrent depression in older patients Source: Reuters Medical News Date: January 06, 1999

•

Efficacy of nortriptyline in boosting smoking cessation rates confirmed Source: Reuters Medical News Date: October 21, 1998

•

Nortriptyline useful for smoking cessation Source: Reuters Medical News Date: August 14, 1998 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “nortriptyline” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or

Periodicals and News

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you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “nortriptyline” (or synonyms). If you know the name of a company that is relevant to nortriptyline, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “nortriptyline” (or synonyms).

Academic Periodicals covering Nortriptyline Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to nortriptyline. In addition to these sources, you can search for articles covering nortriptyline that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 5. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for nortriptyline. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with nortriptyline. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to nortriptyline: Antidepressants, Tricyclic •

Systemic - U.S. Brands: Anafranil; Asendin; Aventyl; Elavil; Endep; Norfranil; Norpramin; Pamelor; Sinequan; Surmontil; Tipramine; Tofranil; Tofranil-PM; Vivactil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202055.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute6: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

6

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:8 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

7

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 8 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway9 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “nortriptyline” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 2148 13 991 1 17 3170

HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.13 Simply search by “nortriptyline” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

9

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

10

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 13

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists14 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.15 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.16 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

14 Adapted 15

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 16 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on nortriptyline can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to nortriptyline. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to nortriptyline. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “nortriptyline”:

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Other guides Attention Deficit Disorder with Hyperactivity http://www.nlm.nih.gov/medlineplus/attentiondeficitdisorderwithhyperactivity.t ml Bipolar Disorder http://www.nlm.nih.gov/medlineplus/bipolardisorder.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html Seniors' Health Issues http://www.nlm.nih.gov/medlineplus/seniorshealthissues.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on nortriptyline. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Antidepressants for Cyclic Vomiting Syndrome Source: Canal Winchester, OH: Cyclic Vomiting Syndrome Association, USA/Canada. 2002. [3 p]. Contact: Available from Cyclic Vomiting Syndrome Association, USA/Canada. 3585 Cedar Hill Road, NW, Canal Winchester, OH 43110. (614) 837-2586. Fax (614) 837-2586. E-mail: [email protected]. Website: www.cvsaonline.org. PRICE: Single copy free. Summary: This newsletter article discusses the use of antidepressants in the treatment of cyclic vomiting in mitochondrial disease. Cyclic vomiting refers to discrete and severe episodes of vomiting, nausea, and lethargy (severe tiredness). Episodes are discrete in that the sufferer is free of nausea and vomiting between episodes. Episodes can occur on a routine schedule, be triggered by physical or psychological stress, or appear to come at random. Cyclic vomiting has many known causes, including intestinal blockage, brain disorders, kidney disease, and several different metabolic disorders. Many of these causes are treatable, so a careful diagnostic work up is important. However, in the vast majority of cases, none of the above causes can be found, and these individuals are given the diagnosis of cyclic vomiting syndrome (CVS). Antidepressants are particularly useful in controlling functional symptoms in conditions including irritable bowel syndrome, functional dyspepsia, and fibromyalgia. Benefits on the physical symptoms

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can be independent of the drugs' psychiatric effects. The tricyclic antidepressants (TCAs), such as amitriptyline, nortriptyline, or desipramine, appear particularly useful, even in low daily dosages that would be considered subtherapeutic from the psychiatric standpoint. No single TCA has surfaced as superior to the other for CVS, although amitriptyline is most often utilized. The author offers guidelines for administration and dosage, patient selection, and coping with side effects of these drugs. 1 figure. 9 references. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “nortriptyline” (or synonyms). The following was recently posted: •

American Gastroenterological Association medical position statement: irritable bowel syndrome Source: American Gastroenterological Association - Medical Specialty Society; 1996 November 10 (revised 2002 Dec); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3685&nbr=2911&a mp;string=nortriptyline

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Assessment and management of acute pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 2000 October (revised 2002 Oct); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3500&nbr=2726&a mp;string=nortriptyline

•

Attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2001 June; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2917&nbr=2143&a mp;string=nortriptyline

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Cardiovascular disease in women: a guide to risk factor screening, prevention and management Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2002; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3487&nbr=2713&a mp;string=nortriptyline

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Clinical practice guideline (second edition) for the diagnosis, treatment, and management of reflex sympathetic dystrophy/complex regional pain syndrome (RSD/CRPS) Source: Reflex Sympathetic Dystrophy Syndrome Association - Private Nonprofit Organization; 2002 February; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3204&nbr=2430&a mp;string=nortriptyline

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Counseling to prevent tobacco use and tobacco-caused disease: recommendation statement. Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2003 Nov); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4314&nbr=3268&a mp;string=nortriptyline

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Depression. A guide to diagnosis and treatment Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2001; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3432&nbr=2658&a mp;string=nortriptyline

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Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 2001; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2779&nbr=2005&a mp;string=nortriptyline

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Guidelines for smoking cessation: revised 2002 Source: New Zealand Guidelines Group - Private Nonprofit Organization; 1999 July (revised 2002 May); 33 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3307&nbr=2533&a mp;string=nortriptyline

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Major depression in adults for mental health care providers Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 February (revised 2002 May); 43 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3354&nbr=2580&a mp;string=nortriptyline

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Major depression, panic disorder and generalized anxiety disorder in adults in primary care Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 January (revised 2002 May); 55 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3350&nbr=2576&a mp;string=nortriptyline

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Management of diabetes. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2001 November; 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3078&nbr=2304&a mp;string=nortriptyline

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Management of type 2 diabetes mellitus Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 March (revised 2002 Sep); 77 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3499&nbr=2725&a mp;string=nortriptyline

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Migraine headache Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1998 November (revised 2002 Jul); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3441&nbr=2667&a mp;string=nortriptyline

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North American Spine Society Phase III: clinical guidelines for multidisciplinary spine care specialists. Spinal stenosis version 1.0. Source: North American Spine Society - Medical Specialty Society; 2002; 91 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3609&nbr=2835&a mp;string=nortriptyline

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Practice guideline for the treatment of patients with major depressive disorder Source: American Psychiatric Association - Medical Specialty Society; 1993 (revised 2000); 45 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2605&nbr=1831&a mp;string=nortriptyline

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Practice parameter: evidence-based guidelines for migraine headache (an evidencebased review). Report of the Quality Standards Subcommittee of the American Academy of Neurology Source: American Academy of Neurology - Medical Specialty Society; 2000 September; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2820&nbr=2046&a mp;string=nortriptyline

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Reflex sympathetic dystrophy/complex regional pain syndrome clinical practice guidelines - third edition Source: International Research Foundation for RSD/CRPS - Private Nonprofit Research Organization; 2003 January 1; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4117&nbr=3162&a mp;string=nortriptyline

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Smoking cessation Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2002 April; 33 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3437&nbr=2663&a mp;string=nortriptyline

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Smoking cessation Source: University of Michigan Health System - Academic Institution; 1998 September (updated 2001 Feb); 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2958&nbr=2184&a mp;string=nortriptyline

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The management of persistent pain in older persons Source: American Geriatrics Society - Medical Specialty Society; 1998 October (revised 2002 Jun); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3365&nbr=2591&a mp;string=nortriptyline

•

Treating tobacco use and dependence. A clinical practice guideline Source: Public Health Service (U.S.) - Federal Government Agency [U.S.]; 2000 June; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2360&nbr=1586&a mp;string=nortriptyline

Patient Resources 95

•

VHA/DOD clinical practice guideline for the management of major depressive disorder in adults Source: Department of Defense - Federal Government Agency [U.S.]; 1997 (updated 2000); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2585&nbr=1811&a mp;string=nortriptyline

The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to nortriptyline. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to nortriptyline. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with nortriptyline.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about nortriptyline. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “nortriptyline” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “nortriptyline”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “nortriptyline” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “nortriptyline” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.17

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

17

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)18: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

18

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 99

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

100 Nortriptyline

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 101

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

102 Nortriptyline

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

103

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

105

NORTRIPTYLINE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH] Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the

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stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and

Dictionary 107

many other compounds. [EU] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anabasine: A botanical insecticide. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Anisotropy: A physical property showing different values in relation to the direction in or along which the measurement is made. The physical property may be with regard to thermal or electric conductivity or light refraction. In crystallography, it describes crystals whose index of refraction varies with the direction of the incident light. It is also called acolotropy and colotropy. The opposite of anisotropy is isotropy wherein the same values characterize the object when measured along axes in all directions. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or

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company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU]

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Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benztropine: A centrally active muscarinic antagonist that has been used in the symptomatic treatment of Parkinson's disease. Benztropine also inhibits the uptake of dopamine. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bethanechol: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Bethanechol is generally used to increase smooth muscle tone, as in the GI tract following abdominal

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surgery or in urinary retention in the absence of obstruction. It may cause hypotension, cardiac rate changes, and bronchial spasms. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bioassay: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biogenic Monoamines: Biogenic amines having only one amine moiety. Included in this group are all natural monoamines formed by the enzymatic decarboxylation of natural amino acids. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the

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bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchial Spasm: Spasmodic contraction of the smooth muscle of the bronchi. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH]

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Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chaos: Complex behavior that seems random but actually has some hidden order. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial)

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bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chlorpromazine: The prototypical phenothiazine antipsychotic drug. Like the other drugs in this class chlorpromazine's antipsychotic actions are thought to be due to long-term adaptation by the brain to blocking dopamine receptors. Chlorpromazine has several other actions and therapeutic uses, including as an antiemetic and in the treatment of intractable hiccup. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citalopram: A selective neuronal serotonin reuptake inhibitor and a clinically effective antidepressant with tolerable side effects. The drug is also effective in reducing ethanol uptake in alcoholics and is used in depressed patients who also suffer from tardive dyskinesia (TD) in preference to tricyclic antidepressants, which aggravate this condition. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clomipramine: A tricyclic antidepressant similar to imipramine that selectively inhibits the uptake of serotonin in the brain. It is readily absorbed from the gastrointestinal tract and demethylated in the liver to form its primary active metabolite, desmethylclomipramine. [NIH]

Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with

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administration of this agent. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive Therapy: A direct form of psychotherapy based on the interpretation of situations (cognitive structure of experiences) that determine how an individual feels and behaves. It is based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior. The therapy uses behavioral and verbal techniques to identify and correct negative thinking that is at the root of the aberrant behavior. [NIH] Colitis: Inflammation of the colon. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1

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to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU]

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Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]

fumarate.

Stimulant

proposed

as

Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclic Vomiting Syndrome: Sudden, repeated attacks of severe vomiting (especially in children), nausea, and physical exhaustion with no apparent cause. Can last from a few hours to 10 days. The episodes begin and end suddenly. Loss of fluids in the body and changes in chemicals in the body can require immediate medical attention. Also called abdominal migraine. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized

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subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Debrisoquin: An adrenergic neuron-blocking drug similar in effects to guanethidine. It is also noteworthy in being a substrate for a polymorphic cytochrome P-450 enzyme. Persons with certain isoforms of this enzyme are unable to properly metabolize this and many other clinically important drugs. They are commonly referred to as having a debrisoquin 4hydroxylase polymorphism. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delusion: A false belief, not susceptible to argument or reason, and determined, pathologically, by some form of mental disorder. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Demethylation: Process that releases substantial amounts of carbon dioxide in the liver. [NIH]

Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or

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esterified form in treatment of conditions that respond generally to cortisone. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH]

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Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electroconvulsive Therapy: Electrically induced convulsions primarily used in the treatment of severe affective disorders and schizophrenia. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emetic: An agent that causes vomiting. [EU] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin

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system and the neurosecretory systems. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Enterohepatic: Of or involving the intestine and liver. [EU] Enterohepatic Circulation: Recycling through liver by excretion in bile, reabsorption from intestines into portal circulation, passage back into liver, and re-excretion in bile. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Induction: An increase in the rate of synthesis of an enzyme due to the presence of an inducer which acts to derepress the gene responsible for enzyme synthesis. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic

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syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Therapy: A form of group psychotherapy. It involves treatment of more than one member of the family simultaneously in the same session. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescence Polarization: Measurement of the polarization of fluorescent light from solutions or microscopic specimens. It is used to provide information concerning molecular size, shape, and conformation, molecular anisotropy, electronic energy transfer, molecular interaction, including dye and coenzyme binding, and the antigen-antibody reaction. [NIH] Fluorescence Polarization Immunoassay: Fluoroimmunoassay where detection of the hapten-antibody reaction is based on measurement of the increased polarization of fluorescence-labeled hapten when it is combined with antibody. The assay is very useful for the measurement of small haptenic antigens such as drugs at low concentrations. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flupenthixol: This tranquilizer seems to be a dopamine-receptor blocker. It works primarily on the D2 receptors, with some effects on the D1 receptors. Craving in some cocaine addicts becomes manageable but is not eliminated. [NIH] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body

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through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanethidine: An antihypertensive agent that acts by inhibiting selectively transmission in post-ganglionic adrenergic nerves. It is believed to act mainly by preventing the release of norepinephrine at nerve endings and causes depletion of norepinephrine in peripheral sympathetic nerve terminals as well as in tissues. [NIH] Haloperidol: Butyrophenone derivative. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH]

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Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homogenate: A suspension of animal tissue that is ground in the all-glass "homogenizer" described by Potter and Elvehjem in 1936. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH]

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Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]

Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a

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specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of

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digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isozymes: The multiple forms of a single enzyme. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Ketotifen: A cycloheptathiophene that interferes with the release of inflammatory mediators and blocks histamine H1 receptors. It has been proposed as an anti-asthmatic and for the treatment of rhinitis, skin allergies, and anaphylaxis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU]

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Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Lipid: Fat. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Lithium Carbonate: A lithium salt, classified as a mood-stabilizing agent. Lithium ion alters the metabolism of biogenic monoamines in the central nervous system, and affects multiple neurotransmission systems. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be

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associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU]

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Mexiletine: Antiarrhythmic agent pharmacologically similar to lidocaine. It may have some anticonvulsant properties. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution.

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[NIH]

Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and

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normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurosyphilis: A late form of syphilis that affects the brain and may lead to dementia and death. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nortriptyline: A metabolite of amitryptyline that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH]

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Obsessional: Neurosis characterized by the repetitive intrusion into the mind, against volition, of ideas, numinations and phobias, often associated with compulsive actions. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Orofacial: Of or relating to the mouth and face. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [NIH]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it

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may be inherited as an autosomal dominant trait. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH]

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Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacogenetics: A branch of genetics which deals with the genetic components of variability in individual responses to and metabolism (biotransformation) of drugs. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phobias: An exaggerated and invariably pathological dread of some specific type of stimulus or situation. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness,

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aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postherpetic Neuralgia: Variety of neuralgia associated with migraine in which pain is felt in or behind the eye. [NIH] Post-synaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of

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health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenstrual: Occurring before menstruation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH]

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Protriptyline: Tricyclic antidepressant similar in action and side effects to imipramine. It may produce excitation. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been

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used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse

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effects limit its clinical use. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU]

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Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selegiline: A selective, irreversible inhibitor of Type B monoamine oxidase. It is used in newly diagnosed patients with Parkinson's disease. It may slow progression of the clinical disease and delay the requirement for levodopa therapy. It also may be given with levodopa upon onset of disability. (From AMA Drug Evaluations Annual, 1994, p385) The compound without isomeric designation is Deprenyl. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotonin Syndrome: An adverse drug interaction characterized by altered mental status, autonomic dysfunction, and neuromuscular abnormalities. It is most frequently caused by use of both serotonin reuptake inhibitors and monoamine oxidase inhibitors, leading to excess serotonin availability in the CNS at the serotonin 1A receptor. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]

Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Sleep Deprivation: The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social

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support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somnolence: Sleepiness; also unnatural drowsiness. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steady state: Dynamic equilibrium. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or

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tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synaptosomes: Pinched-off nerve endings and their contents of vesicles and cytoplasm together with the attached subsynaptic area of the membrane of the post-synaptic cell. They are largely artificial structures produced by fractionation after selective centrifugation of nervous tissue homogenates. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

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Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a

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specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH]

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Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urine Testing: Checking urine to see if it contains glucose (sugar) and ketones. Special strips of paper or tablets (called reagents) are put into a small amount of urine or urine plus water. Changes in the color of the strip show the amount of glucose or ketones in the urine. Urine testing is the only way to check for the presence of ketones, a sign of serious illness. However, urine testing is less desirable then blood testing for monitoring the level of glucose in the body. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valproic Acid: A fatty acid with anticonvulsant properties used in the treatment of epilepsy. The mechanisms of its therapeutic actions are not well understood. It may act by increasing GABA levels in the brain or by altering the properties of voltage dependent sodium channels. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Venlafaxine: An antidepressant drug that is being evaluated for the treatment of hot flashes in women who have breast cancer. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH]

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Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xanthine: An urinary calculus. [NIH] Xanthine Oxidase: An iron-molybdenum flavoprotein containing FAD that oxidizes hypoxanthine, some other purines and pterins, and aldehydes. Deficiency of the enzyme, an autosomal recessive trait, causes xanthinuria. EC 1.1.3.22. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

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INDEX A Abdominal, 105, 109, 116, 126, 132, 133 Abdominal Pain, 105, 126 Aberrant, 4, 105, 114 Activities of Daily Living, 21, 105 Adaptation, 18, 105, 113 Adenosine, 105, 134 Adjustment, 34, 105 Adrenal Medulla, 105, 112, 120, 131 Adrenergic, 105, 107, 108, 109, 117, 118, 120, 122, 136, 137, 146 Adverse Effect, 105, 109, 113, 139, 140 Aerobic, 105, 132 Aerobic Metabolism, 105, 132 Aerobic Respiration, 105, 132 Affinity, 41, 49, 61, 105, 106, 113, 117, 141 Age of Onset, 106, 144 Agonist, 106, 109, 111, 118, 131 Agoraphobia, 106, 124, 132 Akathisia, 26, 106, 108 Albumin, 106, 134 Algorithms, 106, 110 Alkaloid, 106, 111, 114, 129, 131, 137, 138, 146 Alleles, 21, 106 Allopurinol, 40, 42, 106 Allylamine, 106 Alpha-1, 33, 106, 107 Alternative medicine, 76, 106 Amenorrhea, 106, 108, 111 Amine, 13, 106, 110, 123 Amino Acids, 107, 110, 133, 136 Ammonia, 106, 107 Amnestic, 107, 121 Amplification, 12, 107 Amygdala, 6, 107, 127 Anabasine, 15, 107 Anaesthesia, 107, 125 Anal, 13, 107, 127 Analgesic, 13, 107, 124, 129, 132, 138, 142, 144 Analog, 13, 107 Analytes, 13, 107 Anaphylaxis, 107, 126 Anatomical, 21, 107, 109, 124 Angina, 107, 136 Angina Pectoris, 107, 136 Anisotropy, 107, 121

Anorexia, 5, 107, 108 Anorexia Nervosa, 5, 108 Antagonism, 108, 113, 118 Antiarrhythmic, 27, 62, 108, 129 Antibodies, 108, 122, 124 Antibody, 34, 106, 108, 114, 121, 122, 123, 124, 125, 128, 138, 141 Anticholinergic, 14, 45, 59, 107, 108 Anticonvulsant, 108, 111, 127, 129, 145 Antidepressant, 4, 6, 10, 11, 15, 16, 19, 20, 25, 34, 38, 42, 52, 57, 65, 71, 72, 107, 108, 111, 113, 116, 121, 124, 137, 145 Antiemetic, 108, 113 Antigen, 105, 107, 108, 115, 121, 123, 124, 125, 128, 138 Antihypertensive, 108, 122, 138 Anti-inflammatory, 4, 108, 117, 122, 124, 142 Antipsychotic, 32, 108, 113, 130, 134, 138, 143 Antiviral, 108, 125 Anus, 107, 109, 111 Anxiety, 14, 19, 36, 47, 50, 51, 52, 64, 93, 106, 109, 121, 127, 132, 136 Anxiety Disorders, 109, 132 Aorta, 109, 145 Aperture, 109, 137 Apomorphine, 68, 109 Arrhythmia, 108, 109 Arterial, 106, 109, 123, 136, 143 Arteries, 109, 110, 115, 129, 130 Arterioles, 109, 110, 111 Assay, 11, 13, 56, 109, 121, 124, 138 Atenolol, 5, 109 Atrium, 109, 145 Atrophy, 21, 109 Attenuated, 109, 118 Atypical, 109, 113, 131 Autonomic, 108, 109, 122, 131, 133, 140 B Bacterial Physiology, 105, 109 Basal Ganglia, 108, 109, 113, 124, 127 Base, 109, 117, 126, 143 Benign, 109, 122 Benztropine, 17, 109 Bereavement, 25, 35, 60, 63, 109 Bethanechol, 64, 109 Bilateral, 7, 8, 9, 10, 13, 16, 110, 133

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Bile, 110, 120, 121, 127 Bioassay, 43, 110 Biochemical, 28, 41, 64, 106, 110, 140 Biogenic Monoamines, 110, 127 Biological response modifier, 110, 125 Biotechnology, 22, 76, 85, 110 Biotransformation, 110, 134 Bipolar Disorder, 65, 90, 110 Bladder, 39, 110, 145 Blastocyst, 110, 134 Bloating, 110, 126 Blood Platelets, 110, 140 Blood pressure, 35, 108, 110, 113, 123, 124, 129, 131, 141 Blood vessel, 110, 112, 126, 127, 140, 142, 143, 145 Body Fluids, 40, 56, 110, 119, 141 Bone scan, 110, 139 Bowel, 107, 111, 118, 126, 141 Bowel Movement, 111, 118, 141 Bradykinin, 111, 134 Branch, 44, 101, 111, 119, 133, 134, 137, 141, 142, 143 Breakdown, 111, 118, 121 Bromocriptine, 23, 111 Bronchial, 110, 111, 123 Bronchial Spasm, 110, 111 Bronchitis, 111, 113 Bulimia, 5, 111 Bupropion, 27, 50, 62, 111 C Calcium, 111, 114, 118 Capillary, 13, 55, 60, 111, 145 Capsaicin, 4, 111 Capsules, 76, 111 Carbamazepine, 4, 30, 111 Carbohydrates, 105, 111, 132 Carbon Dioxide, 111, 117, 124, 134 Carcinogenic, 112, 125 Cardiac, 15, 27, 62, 106, 108, 110, 112, 119, 120, 127, 130, 137 Cardioselective, 109, 112, 136 Cardiovascular, 18, 62, 91, 112, 140 Carrier Proteins, 112, 134, 138 Case report, 27, 35, 44, 52, 63, 112, 113 Case series, 49, 112, 113 Catecholamine, 11, 112, 118, 134 Caudal, 112, 118, 124, 135 Cell Respiration, 105, 112, 132 Central Nervous System, 112, 113, 114, 122, 127, 129, 140

148

Central Nervous System Infections, 112, 122 Centrifugation, 112, 129, 142 Cerebellum, 112, 116 Cerebral, 5, 13, 109, 112, 115, 117, 120, 121, 133, 137, 141, 143 Cerebrospinal, 27, 33, 43, 112 Cerebrospinal fluid, 27, 33, 43, 112 Cerebrovascular, 19, 20, 112 Cerebrum, 112, 116 Chaos, 46, 112 Chemoreceptor, 108, 112 Chemotaxis, 28, 113 Chlorpromazine, 34, 43, 113, 121, 134 Cholinergic, 107, 108, 113, 131 Chorea, 108, 113 Chromosomal, 107, 113 Chronic, 12, 24, 26, 42, 44, 75, 92, 113, 125, 126, 127, 140 Chronic Obstructive Pulmonary Disease, 42, 92, 113 CIS, 53, 113 Citalopram, 28, 68, 113 Clinical study, 29, 59, 113 Clinical trial, 5, 14, 19, 52, 71, 72, 85, 113, 115, 118, 129, 133, 136, 138 Clomipramine, 29, 113 Cloning, 110, 113 Clozapine, 35, 113 Coagulation, 110, 111, 114, 123, 134 Cocaine, 114, 121 Cochlear, 114, 143, 145 Cochlear Diseases, 114, 143 Coenzyme, 114, 121 Cognition, 3, 19, 62, 114, 130 Cognitive Therapy, 6, 114 Colitis, 114, 126 Combination Therapy, 39, 114 Comorbidity, 55, 72, 114 Complement, 114, 134 Complete remission, 115, 138 Computational Biology, 85, 115 Computed tomography, 115, 139 Computerized axial tomography, 115, 139 Conduction, 62, 115 Congestion, 108, 115 Conjugated, 115, 116 Consciousness, 107, 115, 117, 118 Constipation, 108, 115, 126 Contraindications, ii, 115 Controlled study, 17, 22, 23, 34, 35, 39, 53, 63, 115

149

Convulsions, 108, 115, 119 Coordination, 16, 112, 115 Coronary, 107, 115, 129, 130 Coronary Thrombosis, 115, 129, 130 Cortex, 6, 115, 120, 137 Cortical, 6, 115, 140 Cortices, 13, 116 Cortisone, 116, 118 Cost-benefit, 16, 31, 116 Cotinine, 15, 116 Cranial, 112, 116, 122, 126, 130, 133, 144, 145 Craniocerebral Trauma, 116, 122, 143 Creatinine, 58, 116 Creatinine clearance, 58, 116 Curative, 116, 143 Cutaneous, 12, 116 Cyclic, 19, 90, 116, 135 Cyclic Vomiting Syndrome, 90, 116 Cytochrome, 11, 42, 43, 47, 116, 117 Cytoplasm, 116, 120, 142 D Data Collection, 7, 8, 9, 10, 116 Databases, Bibliographic, 85, 116 Debrisoquin, 43, 117 Decidua, 117, 134 Delirium, 108, 117 Delusion, 49, 117 Dementia, 3, 4, 12, 18, 19, 29, 108, 117, 131 Demethylation, 32, 42, 117 Depersonalization, 117, 132, 139 Depressive Disorder, 7, 8, 9, 10, 30, 35, 53, 55, 93, 95, 117, 127 Deprivation, 60, 117 Derealization, 117, 132 Desipramine, 4, 13, 31, 56, 68, 91, 117 Dexamethasone, 32, 62, 117 Diagnostic procedure, 76, 118 Dialysate, 41, 118 Diarrhea, 118, 126 Diencephalon, 118, 124, 143 Diffusion, 118 Digestion, 110, 111, 118, 119, 126, 127, 141 Digestive system, 73, 118 Dilatation, 118, 136 Diltiazem, 52, 118 Dilution, 13, 118 Direct, iii, 14, 79, 114, 118, 138 Dissociation, 105, 118, 126 Distal, 118, 119, 133 Dizziness, 118, 132

Dopamine, 108, 109, 111, 113, 114, 118, 121, 127, 129, 134 Double-blinded, 14, 118 Drug Interactions, 63, 80, 118 Drug Monitoring, 30, 31, 33, 37, 38, 42, 44, 51, 58, 63, 65, 119 Drug Tolerance, 119, 144 Duct, 119, 139 Dyskinesia, 108, 113, 119 Dyspepsia, 90, 119 Dysphoric, 117, 119 Dyspnea, 119, 132 Dystonia, 108, 119 Dystrophy, 92, 94, 119 E Eating Disorders, 4, 119 Efficacy, 4, 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 19, 24, 29, 30, 76, 119, 144 Elective, 59, 119 Electroconvulsive Therapy, 16, 119 Electrode, 16, 119 Electrolyte, 117, 119, 135, 141 Electrons, 109, 119, 126, 132, 138 Electrophysiological, 119, 145 Embryo, 110, 119, 125 Emetic, 109, 119 Emphysema, 113, 119 Empirical, 19, 119 Endocrine System, 119, 130 Endotoxins, 115, 120, 126 Enterohepatic, 120, 142 Enterohepatic Circulation, 120, 142 Environmental Health, 84, 86, 120 Enzyme, 11, 21, 34, 49, 56, 63, 114, 117, 120, 126, 128, 129, 134, 136, 142, 146 Enzyme Induction, 63, 120 Enzyme Inhibitors, 120, 134 Epinephrine, 105, 118, 120, 131, 144 Ergot, 111, 120 Esophagus, 118, 120, 141 Ethanol, 113, 120 Evoke, 120, 141 Excitability, 120, 137 Excitation, 112, 120, 137 Exhaustion, 108, 116, 120 Exogenous, 110, 120, 136, 144 Extracellular, 120, 141 Extraction, 32, 41, 51, 120 Extrapyramidal, 36, 38, 106, 108, 118, 120 Extremity, 120, 133 F Facial, 17, 120

Nortriptyline

Facial Pain, 17, 120 Family Planning, 85, 121 Family Therapy, 5, 121 Fetus, 121, 134 Fibrinogen, 121, 134 Flatus, 121, 122 Fluorescence, 42, 121 Fluorescence Polarization, 42, 121 Fluorescence Polarization Immunoassay, 42, 121 Fluoxetine, 4, 22, 28, 29, 31, 34, 39, 43, 50, 52, 54, 62, 65, 121 Flupenthixol, 39, 47, 121 Fluphenazine, 39, 46, 47, 48, 51, 121 Fluvoxamine, 28, 121 Forearm, 110, 121 Fractionation, 121, 142 Frail Elderly, 12, 41, 121 Frontal Lobe, 20, 121 G Gallbladder, 105, 118, 121 Gas, 13, 25, 32, 39, 40, 46, 55, 57, 58, 60, 107, 111, 118, 121, 123, 126, 131, 137 Gastrointestinal, 111, 113, 120, 122, 140, 142 Gastrointestinal tract, 113, 120, 122, 140 Gene, 106, 110, 120, 122 Genetics, 40, 122, 134 Genotype, 60, 122, 134 Geriatric, 11, 15, 18, 23, 25, 26, 27, 31, 35, 36, 39, 41, 44, 45, 49, 51, 52, 54, 60, 64, 122 Gestation, 122, 134 Gland, 105, 116, 122, 124, 132, 139, 141, 143 Glossopharyngeal Nerve, 121, 122 Glucocorticoid, 117, 122 Glucose, 5, 122, 125, 145 Glycoprotein, 22, 33, 121, 122 Governing Board, 122, 135 Growth, 108, 122, 125, 128, 130, 134, 143, 144 Guanethidine, 117, 122 H Haloperidol, 4, 122 Haptens, 106, 122, 138 Headache, 93, 94, 122, 123 Headache Disorders, 122, 123 Health Status, 7, 8, 9, 10, 15, 123 Heme, 116, 123, 135 Hemodialysis, 118, 123 Hemorrhage, 116, 122, 123, 142

150

Hemostasis, 123, 140 Hepatic, 106, 117, 123, 129, 135 Heterogeneity, 18, 106, 123 Hiccup, 113, 123 Histamine, 108, 123, 126 Homogenate, 68, 123 Homogeneous, 56, 123 Homologous, 106, 123, 142 Hormonal, 109, 123 Hormone, 110, 116, 120, 123, 125, 136, 143 Hydrogen, 106, 109, 111, 123, 129, 132 Hydroxylation, 31, 32, 38, 42, 49, 53, 60, 61, 68, 123 Hypersensitivity, 12, 107, 123 Hypertension, 123, 126, 136 Hyperthyroidism, 124, 136 Hyperventilation, 48, 50, 124 Hypnotic, 124, 127 Hypokinesia, 124, 133 Hypotension, 22, 24, 30, 54, 57, 65, 108, 110, 115, 124 Hypothalamus, 6, 118, 124, 127, 143 Hypothermia, 68, 124 I Ibuprofen, 4, 124 Id, 69, 91, 92, 93, 94, 95, 100, 102, 124 Imipramine, 4, 5, 13, 27, 28, 30, 31, 35, 56, 68, 113, 124, 137 Immersion, 68, 124 Immunoassay, 34, 42, 124 Immunogenic, 124, 138 Immunoglobulins, 124, 134 Immunologic, 124 Immunology, 105, 124 Impairment, 3, 11, 16, 18, 42, 52, 117, 119, 124, 128, 137 Impotence, 124, 146 In vitro, 11, 28, 32, 49, 124 In vivo, 11, 38, 124, 142 Incubated, 43, 124 Indicative, 124, 133, 145 Induction, 40, 108, 124, 136 Infarction, 125 Infection, 110, 117, 125, 131, 142, 146 Infertility, 111, 125 Inflammation, 106, 108, 111, 114, 125, 139 Ingestion, 65, 125, 135 Inhalation, 123, 125, 135 Initiation, 4, 20, 125 Inotropic, 109, 118, 125 Inpatients, 25, 31, 125 Insulin, 125, 144

151

Interferon, 61, 125 Interferon-alpha, 61, 125 Intermittent, 37, 125, 133 Intervertebral, 125, 128 Intervertebral Disk Displacement, 125, 128 Intestinal, 68, 90, 125 Intestine, 40, 111, 120, 123, 125, 126 Intoxication, 49, 117, 126, 146 Intracranial Hypertension, 122, 126, 143 Intrinsic, 106, 126 Involuntary, 113, 126, 130, 138 Ionization, 55, 126 Ions, 109, 118, 119, 123, 126, 129, 141 Iris, 126, 137 Irritable Bowel Syndrome, 90, 91, 126 Ischemia, 107, 109, 126 Isozymes, 42, 126 J Joint, 4, 126, 141 K Kb, 84, 126 Keto, 41, 61, 126 Ketotifen, 41, 61, 126 Kidney Disease, 73, 84, 90, 126 Kinetic, 63, 126 L Large Intestine, 118, 126, 138 Latency, 51, 126 Lesion, 20, 21, 126, 143 Lethal, 14, 126 Lethargy, 90, 127 Leucocyte, 106, 127 Leukocytes, 125, 127 Levodopa, 127, 140 Library Services, 100, 127 Lidocaine, 127, 129 Limbic, 107, 127 Limbic System, 107, 127 Lipid, 125, 126, 127 Lithium, 7, 8, 9, 10, 11, 17, 26, 45, 57, 108, 127 Lithium Carbonate, 26, 127 Liver scan, 127, 139 Longitudinal study, 20, 127 Lorazepam, 34, 127 Low Back Pain, 24, 127 Lumbar, 125, 127, 128 M Magnetic Resonance Imaging, 128, 139 Maintenance therapy, 23, 128 Malignant, 48, 128

Malnutrition, 106, 109, 128 Mania, 11, 128 Manic, 11, 108, 110, 127, 128, 137 Medial, 6, 128, 132 Mediator, 128, 140 Medical Records, 128, 139 Medical Staff, 118, 128 MEDLINE, 85, 128 Melanin, 126, 128, 134, 144 Membrane, 115, 118, 120, 128, 138, 139, 141, 142 Memory, 4, 66, 107, 117, 128 Menopause, 128, 136 Menstruation, 106, 117, 128, 136 Mental Disorders, 73, 124, 128, 137 Mental Health, iv, 5, 73, 84, 86, 92, 128, 137 Mesolimbic, 108, 128 Metabolic disorder, 90, 128 Metabolite, 18, 29, 31, 42, 43, 47, 53, 55, 60, 65, 110, 113, 128, 131 Mexiletine, 4, 129 MI, 103, 129 Microbe, 129, 144 Microbiology, 105, 109, 129 Microsomal, 47, 55, 129 Modification, 4, 47, 129, 137 Molecular, 14, 47, 85, 87, 110, 115, 121, 129, 136, 138, 144 Molecular Structure, 129, 144 Molecule, 108, 109, 114, 115, 118, 120, 129, 132, 138 Monitor, 116, 129, 131 Monoamine, 129, 140 Monoamine Oxidase, 129, 140 Monotherapy, 15, 25, 129 Morphine, 68, 71, 72, 109, 129, 130, 132 Morphology, 11, 27, 129 Motility, 129, 140 Motion Sickness, 129, 130 Movement Disorders, 108, 129 Mucins, 129, 139 Multicenter study, 55, 129 Muscular Dystrophies, 119, 130 Mydriatic, 130, 146 Myocardial infarction, 115, 129, 130, 136 Myocardium, 107, 129, 130 N Narcotic, 129, 130, 144 Nausea, 90, 108, 116, 130, 132 NCI, 1, 72, 83, 113, 130 Necrosis, 125, 129, 130

Nortriptyline

Need, 3, 7, 18, 96, 105, 130, 144 Neoplastic, 120, 130 Nephropathy, 126, 130 Nerve, 4, 105, 107, 122, 128, 129, 130, 133, 135, 141, 142, 144, 145 Nerve Endings, 122, 130, 142 Nervous System, 112, 128, 130, 131, 133, 142 Neural, 117, 129, 130, 141 Neuralgia, 130, 135 Neuroendocrine, 35, 130 Neuroleptic, 48, 106, 108, 113, 130 Neurologic, 44, 131 Neuromuscular, 131, 140 Neuronal, 113, 131 Neurons, 114, 127, 130, 131, 142, 145 Neuropathy, 4, 48, 131, 133 Neurosyphilis, 131, 133 Neurotransmitters, 107, 131 Nicotine, 14, 15, 71, 131 Nitrogen, 40, 55, 57, 60, 106, 131, 144 Nonverbal Communication, 131, 137 Norepinephrine, 105, 107, 117, 118, 122, 131, 138 Normotensive, 30, 36, 131 Nuclear, 109, 119, 127, 130, 131, 143 Nuclei, 107, 119, 127, 128, 131, 145 Nucleic acid, 131 Nucleus, 116, 125, 131, 145 O Obsessional, 18, 132 Ocular, 68, 132 On-line, 32, 41, 51, 103, 132 Opium, 129, 132 Optic Chiasm, 124, 132 Orofacial, 120, 132 Orthostatic, 24, 30, 54, 65, 108, 132 Outpatient, 18, 132 Overdose, 14, 38, 57, 65, 132 Oxidation, 110, 116, 132 Oxidative metabolism, 57, 105, 132 P Pain Threshold, 13, 132 Palliative, 132, 143 Palsy, 49, 132, 141 Pancreas, 105, 118, 125, 132 Panic, 36, 37, 93, 121, 124, 132 Panic Disorder, 36, 37, 93, 121, 124, 132 Paralysis, 133, 141 Paresis, 68, 133 Paresthesias, 132, 133 Parietal, 6, 133

152

Parietal Lobe, 133 Parkinsonism, 54, 108, 109, 127, 133 Paroxetine, 3, 4, 6, 11, 16, 19, 22, 24, 25, 30, 31, 34, 35, 36, 37, 43, 46, 52, 59, 64, 133 Partial remission, 133, 138 Particle, 59, 133, 141 Patch, 71, 133, 144 Pathologic, 115, 123, 133 Patient Education, 90, 98, 100, 103, 133 Patient Selection, 91, 133 Pelvic, 26, 133 Peptide, 133, 136 Peripheral blood, 125, 133 Peripheral Nervous System, 132, 133, 142 Peripheral Neuropathy, 53, 133 Peritoneal, 118, 133 Peritoneal Dialysis, 118, 133 Perphenazine, 13, 23, 39, 44, 62, 134 Pharmacodynamic, 11, 29, 33, 134 Pharmacogenetics, 56, 134 Pharmacokinetic, 11, 28, 29, 31, 51, 52, 134 Pharmacologic, 11, 18, 134, 144, 145 Pharmacotherapy, 7, 8, 9, 10, 17, 31, 39, 52, 60, 134 Phenotype, 43, 134 Phenylalanine, 134, 144 Phobias, 132, 134 Phosphorus, 60, 111, 134 Physical Therapy, 13, 134 Physiologic, 46, 106, 124, 128, 134, 138, 144 Pilot study, 11, 19, 64, 134 Placenta, 63, 134 Plants, 106, 111, 114, 122, 129, 131, 134 Plasma protein, 23, 106, 134, 140 Platelet Activation, 37, 134 Platelets, 43, 134, 135, 143 Platinum, 53, 135 Poisoning, 52, 109, 117, 120, 126, 130, 135 Polymorphic, 117, 135 Polymorphism, 22, 117, 135 Porphyria, 37, 135 Porphyrins, 135 Posterior, 107, 112, 122, 126, 132, 135 Postherpetic Neuralgia, 50, 71, 135 Post-synaptic, 135, 142 Postural, 22, 34, 36, 135 Potassium, 135, 137 Potentiates, 117, 135 Potentiating, 107, 135 Practicability, 135, 144 Practice Guidelines, 15, 86, 91, 94, 135 Precursor, 118, 127, 131, 134, 136, 144

153

Premenstrual, 64, 136 Prevalence, 5, 15, 136 Probe, 12, 136 Prognostic factor, 136, 142 Progression, 136, 140 Progressive, 4, 49, 117, 119, 122, 130, 134, 136 Prolactin, 111, 136 Propranolol, 68, 109, 136 Prospective study, 127, 136 Protease, 114, 136 Protein Binding, 42, 136 Protein S, 110, 136 Proteins, 12, 107, 108, 112, 114, 129, 131, 133, 134, 136, 138, 140 Proteolytic, 106, 114, 121, 136 Protocol, 12, 136 Protriptyline, 48, 137 Psychiatric, 15, 16, 18, 19, 23, 52, 54, 55, 72, 91, 93, 128, 137, 140 Psychic, 137, 140 Psychomotor, 111, 117, 131, 137 Psychosis, 108, 137 Psychotherapy, 5, 15, 34, 48, 63, 76, 114, 121, 137 Psychotropic, 4, 137 Public Health, 7, 8, 9, 86, 94, 137 Public Policy, 85, 137 Pulmonary, 110, 124, 137, 145 Pulmonary Artery, 110, 137, 145 Pulmonary Ventilation, 124, 137 Pulse, 50, 129, 137 Pupil, 68, 130, 137 Pyramidal Tracts, 120, 137 Q Quality of Life, 21, 137 Quinidine, 61, 68, 137 Quinine, 137 R Radiation, 107, 116, 121, 138, 139, 146 Radioactive, 110, 123, 126, 127, 131, 138, 139 Radioimmunoassay, 11, 25, 46, 56, 138 Randomized clinical trial, 7, 8, 9, 15, 18, 24, 138 Receptor, 35, 105, 108, 112, 113, 118, 121, 138, 140 Receptors, Serotonin, 138, 140 Rectum, 109, 111, 118, 121, 122, 126, 138 Recurrence, 6, 16, 18, 20, 45, 51, 110, 138 Refer, 1, 114, 118, 130, 137, 138 Reflex, 92, 94, 138

Refractory, 21, 27, 138 Regimen, 12, 42, 119, 134, 138, 139 Relapse, 7, 8, 9, 10, 15, 16, 18, 20, 21, 138 Remission, 3, 20, 21, 52, 110, 128, 138 Reserpine, 68, 138 Response rate, 16, 21, 139 Restoration, 134, 139 Retreatment, 54, 139 Retrospective, 25, 47, 139 Retrospective study, 25, 139 Rheumatism, 124, 139 Rhinitis, 126, 139 Rigidity, 133, 134, 139 Risk factor, 15, 19, 20, 38, 91, 136, 139 S Saliva, 38, 50, 139 Salivary, 53, 118, 139 Salivary glands, 118, 139 Scans, 19, 20, 139 Schizoid, 139, 146 Schizophrenia, 43, 119, 139, 146 Schizotypal Personality Disorder, 117, 139, 146 Screening, 3, 91, 113, 139 Secretion, 111, 123, 129, 139 Sedative, 107, 124, 127, 139 Seizures, 57, 111, 117, 140 Selegiline, 54, 140 Self Care, 105, 140 Semisynthetic, 111, 140 Serologic, 124, 140 Serotonin Syndrome, 54, 140 Sertraline, 18, 20, 29, 30, 36, 41, 76, 140 Serum, 25, 28, 29, 32, 38, 41, 51, 55, 59, 60, 65, 106, 114, 138, 140 Serum Albumin, 138, 140 Side effect, 7, 8, 9, 10, 14, 16, 18, 21, 45, 64, 79, 91, 105, 106, 108, 113, 127, 137, 140, 142, 144 Signs and Symptoms, 36, 138, 140 Skeletal, 130, 137, 140 Skeleton, 126, 140 Sleep Deprivation, 25, 140 Smooth muscle, 59, 106, 109, 111, 123, 129, 140, 142 Social Environment, 137, 140 Social Support, 15, 140 Sodium, 36, 137, 138, 141, 145 Sodium Channels, 138, 141, 145 Soma, 141 Somatic, 4, 12, 122, 127, 133, 141 Somnolence, 4, 141

Nortriptyline

Sound wave, 115, 141 Spastic, 126, 141 Specialist, 96, 141 Species, 111, 120, 137, 141, 146 Specificity, 106, 141 Spinal cord, 112, 130, 131, 133, 137, 138, 141 Sprains and Strains, 128, 141 Staging, 139, 141 Steady state, 12, 28, 59, 141 Stimulus, 12, 119, 120, 126, 133, 134, 138, 141, 143 Stomach, 105, 118, 120, 122, 123, 130, 141 Stool, 126, 141 Stress, 90, 112, 126, 130, 141 Stroke, 50, 72, 73, 84, 142 Stupor, 127, 130, 142 Subarachnoid, 122, 142 Subclinical, 125, 140, 142 Substance P, 128, 139, 142 Substrate, 57, 117, 120, 142 Sulindac, 4, 142 Suppression, 32, 62, 142 Survival Analysis, 16, 18, 51, 142 Symptomatic, 16, 48, 109, 142 Symptomatic treatment, 48, 109, 142 Symptomatology, 5, 142 Synaptic, 131, 142 Synaptic Transmission, 131, 142 Synaptosomes, 43, 142 Synergistic, 46, 136, 142 Systemic, 80, 107, 109, 110, 117, 120, 125, 126, 143 Systolic, 36, 123, 143 Systolic blood pressure, 36, 143 T Tachycardia, 46, 143 Tardive, 108, 113, 143 Temporal, 107, 123, 143 Temporal Lobe, 107, 143 Teratogenic, 118, 143 Thalamus, 13, 118, 127, 143 Therapeutics, 28, 29, 33, 34, 36, 38, 40, 41, 43, 45, 53, 63, 80, 129, 143 Thiothixene, 4, 143 Third Ventricle, 124, 143 Threshold, 16, 120, 123, 143 Thrombocytes, 135, 143 Thrombosis, 136, 142, 143 Thyroid, 124, 143, 144 Tidal Volume, 124, 143 Tin, 133, 135, 143

154

Tinnitus, 24, 64, 143, 145 Tissue, 108, 109, 111, 112, 114, 119, 123, 124, 126, 128, 130, 131, 133, 134, 139, 140, 141, 142, 143 Tolerance, 13, 144 Tomography, 12, 115, 144 Tooth Preparation, 105, 144 Topical, 4, 120, 144 Toxic, iv, 131, 144 Toxicity, 50, 118, 144 Toxicology, 40, 59, 86, 144 Tramadol, 4, 144 Transcutaneous, 4, 144 Transdermal, 71, 144 Transfection, 110, 144 Treatment Outcome, 15, 27, 43, 62, 144 Tremor, 133, 144 Tricyclic, 3, 4, 10, 13, 14, 24, 38, 42, 65, 71, 72, 80, 91, 107, 113, 117, 124, 137, 144 Trigeminal, 121, 144 Trigger zone, 108, 144 Tryptophan, 140, 144 Type 2 diabetes, 93, 144 Tyrosine, 54, 118, 144 U Unconscious, 124, 144 Urethra, 145 Uric, 106, 145 Urinary, 15, 26, 65, 110, 145, 146 Urinary Retention, 110, 145 Urine, 10, 42, 110, 116, 145 Urine Testing, 10, 145 V Vaccine, 136, 145 Valproic Acid, 38, 145 Vascular, 20, 21, 106, 107, 123, 125, 134, 145 Venlafaxine, 16, 38, 60, 65, 145 Ventricle, 11, 107, 137, 143, 145 Ventricular, 35, 62, 145 Ventricular Function, 35, 145 Venules, 110, 111, 145 Vesicular, 129, 145 Vestibulocochlear Nerve, 143, 145 Vestibulocochlear Nerve Diseases, 143, 145 Veterinary Medicine, 85, 146 Virulence, 109, 144, 146 Virus, 112, 125, 146 Viscera, 141, 146 Vitro, 146 Vivo, 146

155

Volition, 126, 132, 146 W White blood cell, 108, 124, 127, 146 Withdrawal, 71, 117, 146 X Xanthine, 106, 146

Xanthine Oxidase, 106, 146 X-ray, 115, 121, 131, 139, 146 Y Yeasts, 134, 146 Yohimbine, 36, 65, 146

Nortriptyline

156