580 AMITRIPTYLINE THERAPY IN PATIENTS WITH ANOREXIA NERVOSA
WEIGHT LOSS BEFORE AND WEIGHT GAIN AFTER AMITRIPTYLINE THERAPY
SIR Besides food aversion, weight loss, and amenorrhoea, many patients with anorexia nervosa display signs of motor and speech retardation and express feelings of sadness. Because of this, we used a tricyclic antidepressant, amitriptyline, in the management of six consecutive patients with this
syndrome. The patients were five young women between the ages of 11 and 17 years, and one 16-year-old male. All had severe aversion to food and weight loss greater than 20%. All of the females were amenorrhceic. After admission to the pacdiatric ward, the patients were put on oral amitriptyline in individually determined doses, ranging between 75 mg and 150 mg per day. Patients consulted with a dietitian daily, were asked to keep a diet diary, and encouraged, but not coerced, to in-
the rigid, obsessive compulsive, often stereotyped behaviour in anorectic patients resembles that seen in patients with Parkinson’s disease. The positive response of the patients to amitriptyline may be due to a general mood-elevating effect, and may be in part a result of hospital admission. However, the prompt improvement in temperature regulation, motor behaviour, speech, and appetite suggest that a more specific effect of the drug on hypothalamic catecholamine function might account for these combined changes. The mechanism of this response seems worthy of controlled and systematic study. Department of Psychiatry, HERBERT L. NEEDLEMAN Children’s Hospital Medical Center, DEBORAH WABER Massachusetts U.S.A. Boston, 02115,
GENTAMICIN-RESISTANT STAPHYLOCOCCUS AUREUS
SIR,-Dr Brown and his colleagues (Aug. 21, p. 419;
gentamicin-resistant strain of Staphylococcus possessed two gentamicin-modifying enzymes-a phosphotransferase and an acetyltransferase. We have examined five gentamicin-resistant strains of Staph. aureus, isolated in St Thomas’ Hospital in 1976, for the presence of such enzymes. Ultrasonically treated suspensions of cells grown in Oxoid nutrient broth no. 2 were tested for their ability to bind radioactivity from [Y 32P] adenosine-5’-triphosghate or [1-14C] acetylcoenzyme A to aminoglycosides (6-5 mg/1) in the reported aureus
Weight changes in
six
patients with
anorexia
nervosa
given amitripty-
line.
their intake of food. No systematic psychotherapy or behaviour modification was used. All patients began to gain weight between the 6th and 12th day of drug treatment. This was always preceded by a rather striking brightening of mood, increased warmth of extremities, and noticeable improvement in social relationships. The ward staff noted that eating behaviour changed; time taken to select menus and eat meals shortened noticeably. Patients spontaneously made such statements as: "I don’t think about food as much" or "Eating is not as big a deal." Four of the patients were noted on admission to have slow speech, immobility of the lower face, rigidity of the shoulders, and a small gait, suggesting a parkinsonian-like movement disorder. This also improved after drug administration. Patients D, E, and F had infectious gastroenteritis while on medication that led to temporary weight loss, and patient D was taken off amitriptyline when the gastroenteritis began. After 20 days off the drug she began to decrease her intake, appear sad, and withdraw from friends. The drug was restarted, and after 14 days she again began to gain weight and seek out her friends. A number of studies have demonstrated evidence of hypothalamic dysfunction in patients with anorexia nervosa.l2 Johanson and Knorr3treated six patients with anorexia with levodopa and found improvement in four. They also noted that
crease
1. Wakeling, A., Russell, G. F. M. Psychol. Med. 1970, 1, 30. 2. Boyar, R. M., Katz, J., Finkelstein, J. W., Kapen, S., Weiner, E. D., Hellman, L. New Engl.J. Med. 1974, 291, 861. 3. Johanson, A. J., Knorr, N. J. Lancet, 1974, ii, 591.
H., Weitzman,
a
that
ENZYME ACTIVITY FOR AMINOGLYCOSIDES
presence of tris(hydroxymethyl)aminomethane hydrochloride buffer pH 7.6(55 mmol/1), magnesium chloride (8.7 mmol and dithiothreitol (2-7 mmol/1). Aminoglycosides were subse from other material by cellulose phospha:: quently separated 1 paper binding.’ 1. Benveniste,
R., Davies, J. A. Rev. Biochem. 1973, 42, 471.
WEIGHT LOSS BEFORE AND WEIGHT GAIN AFTER AMITRIPTYLINE THERAPY
SIR Besides food aversion, weight loss, and amenorrhoea, many patients with anorexia nervosa display signs of motor and speech retardation and express feelings of sadness. Because of this, we used a tricyclic antidepressant, amitriptyline, in the management of six consecutive patients with this
syndrome. The patients were five young women between the ages of 11 and 17 years, and one 16-year-old male. All had severe aversion to food and weight loss greater than 20%. All of the females were amenorrhceic. After admission to the pacdiatric ward, the patients were put on oral amitriptyline in individually determined doses, ranging between 75 mg and 150 mg per day. Patients consulted with a dietitian daily, were asked to keep a diet diary, and encouraged, but not coerced, to in-
the rigid, obsessive compulsive, often stereotyped behaviour in anorectic patients resembles that seen in patients with Parkinson’s disease. The positive response of the patients to amitriptyline may be due to a general mood-elevating effect, and may be in part a result of hospital admission. However, the prompt improvement in temperature regulation, motor behaviour, speech, and appetite suggest that a more specific effect of the drug on hypothalamic catecholamine function might account for these combined changes. The mechanism of this response seems worthy of controlled and systematic study. Department of Psychiatry, HERBERT L. NEEDLEMAN Children’s Hospital Medical Center, DEBORAH WABER Massachusetts U.S.A. Boston, 02115,
GENTAMICIN-RESISTANT STAPHYLOCOCCUS AUREUS
SIR,-Dr Brown and his colleagues (Aug. 21, p. 419;
gentamicin-resistant strain of Staphylococcus possessed two gentamicin-modifying enzymes-a phosphotransferase and an acetyltransferase. We have examined five gentamicin-resistant strains of Staph. aureus, isolated in St Thomas’ Hospital in 1976, for the presence of such enzymes. Ultrasonically treated suspensions of cells grown in Oxoid nutrient broth no. 2 were tested for their ability to bind radioactivity from [Y 32P] adenosine-5’-triphosghate or [1-14C] acetylcoenzyme A to aminoglycosides (6-5 mg/1) in the reported aureus
Weight changes in
six
patients with
anorexia
nervosa
given amitripty-
line.
their intake of food. No systematic psychotherapy or behaviour modification was used. All patients began to gain weight between the 6th and 12th day of drug treatment. This was always preceded by a rather striking brightening of mood, increased warmth of extremities, and noticeable improvement in social relationships. The ward staff noted that eating behaviour changed; time taken to select menus and eat meals shortened noticeably. Patients spontaneously made such statements as: "I don’t think about food as much" or "Eating is not as big a deal." Four of the patients were noted on admission to have slow speech, immobility of the lower face, rigidity of the shoulders, and a small gait, suggesting a parkinsonian-like movement disorder. This also improved after drug administration. Patients D, E, and F had infectious gastroenteritis while on medication that led to temporary weight loss, and patient D was taken off amitriptyline when the gastroenteritis began. After 20 days off the drug she began to decrease her intake, appear sad, and withdraw from friends. The drug was restarted, and after 14 days she again began to gain weight and seek out her friends. A number of studies have demonstrated evidence of hypothalamic dysfunction in patients with anorexia nervosa.l2 Johanson and Knorr3treated six patients with anorexia with levodopa and found improvement in four. They also noted that
crease
1. Wakeling, A., Russell, G. F. M. Psychol. Med. 1970, 1, 30. 2. Boyar, R. M., Katz, J., Finkelstein, J. W., Kapen, S., Weiner, E. D., Hellman, L. New Engl.J. Med. 1974, 291, 861. 3. Johanson, A. J., Knorr, N. J. Lancet, 1974, ii, 591.
H., Weitzman,
a
that
ENZYME ACTIVITY FOR AMINOGLYCOSIDES
presence of tris(hydroxymethyl)aminomethane hydrochloride buffer pH 7.6(55 mmol/1), magnesium chloride (8.7 mmol and dithiothreitol (2-7 mmol/1). Aminoglycosides were subse from other material by cellulose phospha:: quently separated 1 paper binding.’ 1. Benveniste,
R., Davies, J. A. Rev. Biochem. 1973, 42, 471.
