94 Nocturnal MEL production is a direct output of the SCN circadi

94 Nocturnal MEL production is a direct output of the SCN circadian clock. Exogenous

MEL is effective at a time when endogenous MEL is not. produced or present in the general circulation. Consequently the effects of MEL administration in vivo, as important as they are in terms of Panobinostat potential clinical applications, appear not to be related to the role of endogenous MEL on circadian functioning. This conclusion is reinforced by the observation that to obtain entrainment of the circadian activity rhythm of rodents kept under constant, darkness, high doses of MEL have to be used, independently of the mode of administration.131,133,142 These doses of MEL Inhibitors,research,lifescience,medical produce peak serum levels 100- to 1000-fold higher than the endogenous MEL nighttime levels. The necessity of such a high dose of MEL is unlikely to be a consequence of its rapid metabolism. Appropriate photoperiodic response Inhibitors,research,lifescience,medical is, indeed, obtained when MEL is administered

via a similar subcutaneous infusion system with a dose that Inhibitors,research,lifescience,medical mimics the endogenous secretion profile.94,143 Most likely, this high dose of MEL is needed because it is an integral part of the response observed. Especially because in vitro administration of MEL can phase shift, the firing rate of SCN neurons in brain slices (rat, mouse),69,144 it is generally believed that. MEL mediates these effects through the high-affinity MET. receptors located within the SCN.29,107,125 This view is supported by the high correlation between the density of MEL receptors within the SCN and the ability of daily MEL administration to entrain

the free-running activity rhythm Inhibitors,research,lifescience,medical in mammals. Contrary to the rat, mouse, and Djungarian hamster, rodents that can be entrained by daily MEL administrations and in which a high density of MEL receptors is observed within the SCN, the mink (Muslela vison) does Inhibitors,research,lifescience,medical not. appear to have specific MEL receptors (at. least 2-iodomelatonin binding sites) within the SCN. This animal docs not entrain to MEL.89 Newborn Syrian hamsters express MET. receptors in the SCN, but shortly after birth the receptor number decreases.145,146 Young hamsters are entrainable by daily acute MET. administration, while in the adult. MET. cannot entrain129,147,148 or can only do so under particular Dipeptidyl peptidase experimental conditions (eg, long-term infusions).132,149 Since SCN-lesioned hamsters whose rhythmicity has been restored with fetal hypothalamic graft are entrained by daily MEL injection, and since MET. is known to accelerate the reentrainment of circadian rhythm in rat. subjected to a shift in the LD cycle,134 it is clear that the chronobiotic effect, of MEL is the consequence of a direct action on the clock.

These results also highlight an

These results also highlight an interesting and important issue, namely that by selecting a representative subset of samples, significant metabolic information can be retrieved from a small number of samples, information by the presented method that can be predictively verified in follow up studies. This is important since it is not reasonable to believe that all future studies of value should include thousands of samples. Instead, there could be value in detecting potentially relevant

information in small, well designed studies. The benefits of this will be many, including Inhibitors,research,lifescience,medical an efficient use of biobank samples, as well as better possibilities for maintaining a high analytical data quality, which is a major problem when analyzing large sample sets over longer times with mass spectrometry. It is also worth noting Inhibitors,research,lifescience,medical that the same EPZ004777 strategy as above, namely selecting representative sample subsets from acquired GC/MS data and utilizing the predictive feature of the H-MCR method, was used as an internal cross-validation procedure

for the H-MCR curve resolution as a means to obtain a robust and reliable metabolite pattern on which to base further modeling and interpretations. Thus, the whole chain of events, including multivariate Inhibitors,research,lifescience,medical curve resolution and sample classification, is subject to an internal cross-validation procedure, as well as Inhibitors,research,lifescience,medical providing the possibility for prediction of new independent samples, which to our knowledge makes the proposed strategy unique. Of high importance for an efficient screening of large sample

sets is the time and feasibility for producing representative data. Curve resolution methods are, in general, very time-consuming and demanding in terms of computer capacity, which limits the number of samples that can actually be processed. However, the predictive feature of the H-MCR method can resolve this issue. In the given example, H-MCR processing of the 16 samples took 6h and 29 min to resolve, while Carnitine palmitoyltransferase II predictive processing of Inhibitors,research,lifescience,medical the remaining 77 samples took <10sec/sample. This indicates that as long as the selected subset is representative in terms, retained variation large sample quantities can be efficiently processed, providing data of high quality for sample comparisons, biomarker detection and identification, and predictions. It should be pointed out that the number of samples used in this example cannot be considered as a particularly large sample or data set. However, the point was proven that samples could be efficiently processed, with retained data quality, based on a selected set of representative samples, and as far as the method goes, there is no limitation to the number of samples that can be predictively processed in the same way as shown here.

First, no significant loss of AChR at NMJ was observed in biopsie

First, no significant loss of AChR at NMJ was observed in biopsies from biceps brachii muscles of MuSK-positive patients with MG (20). Second, MuSK antibodies are mainly in the IgG4 subclass, which does not activate complement (9), and complement-mediated damage to postsynaptic membranes is considered a major source of pathogenicity in MG patients with AChR antibodies. Third, passive

transfer of MuSK serum in MG patients Inhibitors,research,lifescience,medical cannot generate the equivalent disease in mice. Fourth, no experimental animal model induced by MuSK had been developed. Although none of these studies seems to support a pathogenic role for MuSK antibodies in human MG, MuSK antibodies from MG patients effectively inhibit MuSK functions in vitro (5). An experimental animal model Inhibitors,research,lifescience,medical of myasthenia (EAMG) induced by MuSK antibodies The pathogenicity of AChR antibodies was shown experimentally by the induction of muscle weakness and development of paralysis in rabbits immunized with AChR protein purified from the electric eel (3). This AChR protein induced the production of antibodies that cross-reacted with rabbit AChR at the NMJ. The flaccid paralysis that followed and electrophysiological Inhibitors,research,lifescience,medical studies of these animals provided a model that resembled the MG of humans (21). Furthermore, this EAMG could be transferred by injecting sera from the paralyzed rabbits into naïve animals, indicating that the antibodies rather than cellular

immunity caused the disease. Subsequently, EAMG was also induced in other species by repeated inoculations with purified AChR protein. The pathogenic nature Inhibitors,research,lifescience,medical of these antibodies from MG patients was demonstrated by passive transfer of the IgG fraction

into mice. In addition to these experimental studies indicating the pathogenicity of AChR antibodies, clinical laboratory analyses determined Inhibitors,research,lifescience,medical that the patients had serum antibodies that were specific for AChR. Therefore, the next step was using MuSK antibodies to induce an EAMG model, which was essential for proving their pathogenicity and investigating their mechanisms of eliciting MG. Recently we demonstrated that immunization of rabbits with MuSK ectodomain caused myasthenic weakness and produced selleck electromyographic findings that were compatible with a diagnosis of MG (16), as shown by Patrick and Lindstrom. The extracellular segment of MuSK comprised five distinct domains, i.e., four immunoglobulin-like domains and one cysteine-rich region. The fusion protein expression constructs, Metalloexopeptidase which consisted of mouse MuSK ectodomain with the Fc region of human IgG1 or His-tag, were generated and transfected in COS-7 cells. The secreted recombinant MuSK-Fc and MuSK-His proteins were purified by using protein-A Sepharose and histidine affinity columns, respectively. New Zealand White rabbits were then immunized with 100 to 400 mg of purified MuSK recombinant protein. After three to four injections of MuSK protein, all of six rabbits manifested flaccid paralysis (Fig. ​(Fig.1A).1A).

Therefore, the emphasis must be on families and less so on a sing

Therefore, the emphasis must be on families and less so on a single case or the proband. In a single individual, one at best could surmise the causal variant, although not with high certainty. B. nsSNVs. By changing the amino acid sequence in the protein, the nsSNVs are more likely to be pathogenic than the synonymous variants, although there might be exceptions. The vast majority of Inhibitors,research,lifescience,medical the 13,500 nsSNVs in each exome are unlikely to be pathogenic. C. Rare variants. Rare variants are more likely to be pathogenic than common variants for reasons that were discussed earlier. Common and uncommon variants that have a population frequency greater than the prevalence of the disease

are unlikely Inhibitors,research,lifescience,medical to be pathogenic. A variant that is absent in the databases and therefore considered novel is a stronger candidate. D. LoF variants. SNVs

that result in premature truncation of the encoded protein, such as stop codon mutations and frameshift variants, are stronger pathogenic variants. E. De novo variants. Variants that are present in the affected probands but absent in the healthy parents are strong candidates to be pathogenic. F. Functional rare variants in genes previously implicated in the pathogenesis of the phenotype. Inhibitors,research,lifescience,medical Rare nsSNVs in known causal genes for the phenotype are likely but not definitively causal in an index case. G. Common and uncommon variants – nsSNV or otherwise – previously shown to be associated with a common phenotype. The clinical impact of these variants is relatively modest. Clinically Guided Classification of the DSVS The algorithms used to NLG919 chemical structure identify the causal variants often do Inhibitors,research,lifescience,medical not result in a definitive isolation of the pathogenic variants but often provide a probable weight. To simplify the Inhibitors,research,lifescience,medical clinical decision making, we have classified the DSVs in the genome into five categories, as follows17: A. Disease-causing variants. These variants are rare in each genome/exome and are typically responsible for single-gene diseases. They are typically

missense, nonsense, or frameshift variants. When present, these variants cause the disease, although expressivity is variable and the major determinant of the why severity of the phenotype. Several other genetic and nongenetic factors also contribute to the phenotypic expression of the disease.19, 20 Identifying these variants through WES has the highest impact on the care of the individual and family. B. Likely disease-causing variants. These variants are typically rare LoF variants that are absent in the general population. However, despite being functional and rare or even exclusive to an individual or family, these variants do not show a perfect cosegregation, partly because of low penetrance.21, 22 These variants have the second largest effect sizes on the phenotype. C. Disease-associated variants.

) Mixed-effects models can include all data from participants, ev

) Mixed-effects models can include all data from participants, even those who terminate the study prematurely.7,8 Analyses of the sensitivity of results to the assumptions

of the analytic model are useful components of a data analysis plan. These can include use of pattern-mixture BMS-345541 in vitro models26,27 and the assessment and application of predictors of attrition such as the two-item Intent to Attend questionnaire.28 A second observational component of an RCT is the flexible-dose study, in which those who l’ail to respond to a low dose are then offered a greater dose of the intervention. Such a design is inappropriate for dose finding because “self-selection” Inhibitors,research,lifescience,medical determines dose. Fortunately, the use of flexible dose RCTs is more limited today than two or three decades ago. The problem of flexible dosing can be obviated by conducting a fixeddose study that allows Inhibitors,research,lifescience,medical lor a brief period of titration.29 In summary if conditions allow, a RCT is preferable for intervention evaluation. However, there are clinical contexts and patient types that do not lend themselves

to randomized treatment assignment (eg, suicidal patients). In such a case, an observational study can inform treatment choice if an appropriate adjustment, such as the propensity score adjustment, is implemented. Regardless of the design, the generalizability of the results is restricted to the type of participants Inhibitors,research,lifescience,medical included in the study. Acknowledgments Dr Leon has received Inhibitors,research,lifescience,medical research support from the National Institute of Mental Health (MH060447, MH068638 and MH092606). In the past 12 months he has served on independent Data and Safety Monitoring Boards for AstraZeneca, Pfizer and Sunovion and has been a consultant to FDA, NIMH, MedAvante and Roche. He has equity in MedAvante.
Depression occurs commonly, but not inevitably, in patients with cancer at the end of life. Although there are over 7 million cancer deaths Inhibitors,research,lifescience,medical around the world each year,1 estimates of the prevalence of depression in terminally ill cancer patients are imprecise. Most studies of comorbid cancer and depression either make no

distinction between cancer phases (eg, newly diagnosed, active treatment, survivorship, stable metastatic disease, end-stage) or fail to operationally define “end-of-life” care. Consequently, reported prevalence rates those for depression in patients with cancer span a broad range. Best estimates are that between 15% and 50% of cancer patients experience depressive symptoms, and 5% to 20% will meet various diagnostic criteria for major depressive disorder.2-7 Similarly, few data are available with respect to the frequency with which cancer patients are appropriately treated for depression at the end of life.8,9 Only a small number of controlled clinical trials have been conducted with depressed cancer patients, whether or not they are in a terminal phase of their illness.

In retrospect, the decision to start the purification efforts wit

In retrospect, the decision to start the purification efforts with fraction I turned out to be important, as fraction I contained only one single protein—APF-1—that was necessary to stimulate proteolysis of the model substrate we used at the time, while fraction II turned out to contain many more. Later studies showed that fraction I contains other components necessary for the degradation of other substrates, but these were not necessary for the reconstitution of the

system at that time. This enabled us not only to purify APF-1 but also to decipher quickly its mode of action. If Inhibitors,research,lifescience,medical we had started our purification efforts with fraction II, we would have encountered a significantly bumpier road. A critically important finding that paved the way for future developments in the field was that multiple moieties of APF-1 are covalently conjugated to the target substrate when incubated in the presence of fraction II, and the modification requires Inhibitors,research,lifescience,medical ATP (Figure 3 and Figure 4).39,40 It was also found that the modification is reversible and APF-1 could be removed from the substrate or its degradation products.40 Table 1 Resolution of the ATP-dependent proteolytic activity from crude reticulocyte extract

Inhibitors,research,lifescience,medical into two essentially required complementing activities (adapted from Ciechanover et al.38; with permission from Elsevier/Biochem Biophys Res Commun). Figure 3 APF-1/ubiquitin is shifted to high-molecular-mass compound(s) following incubation in ATP-containing crude cell extract. Figure 4 Multiple molecules of APF-1/ubiquitin are conjugated to the proteolytic substrate, probably signaling it for degradation. The discovery that APF-1 was covalently conjugated to protein substrates and stimulates their proteolysis in the presence of ATP and crude fraction II led in Inhibitors,research,lifescience,medical 1980 to the proposal of a model according Inhibitors,research,lifescience,medical to which protein substrate modification by multiple moieties of APF-1 MLN2238 in vitro targets it for degradation by a downstream, at that time yet unidentified, protease that cannot recognize the

unmodified substrate; following degradation, reusable APF-1 was released.40 Amino acid analysis of SB-3CT APF-1, along with its known molecular mass and other general characteristics, raised the suspicion that APF-1 was ubiquitin,41 a known protein of previously unknown function. Indeed, Wilkinson and colleagues confirmed unequivocally that APF-1 was indeed ubiquitin.42 Ubiquitin had been first described as a small, heat-stable, and highly evolutionarily conserved protein of 76 residues. It was first purified during the isolation of thymopoietin43 and was subsequently found to be ubiquitously expressed in all kingdoms of living cells, including prokaryotes.44 Interestingly, it was initially found to have lymphocyte-differentiating properties, a characteristic that was attributed to the stimulation of adenylate cyclase.44,45 Accordingly, it was named UBIP for ubiquitous immunopoietic polypeptide.

The secondary antibody was FITC-conjugated anti-rat antibody at a

The secondary antibody was FITC-conjugated anti-rat antibody at a concentration of 1:200. The alkaline phosphatase activity was also assessed using the alkaline phosphatase kit (Sigma). The staining procedure was done according to

the manufacturer’s instruction. Results Cytotoxicity Assay The cardiomyocyte extract was not toxic; consequently, 92.3% of the unpermeabilized cells exposed to the extract for one h were viable. The extract-treated cells as well as the control cells that were Inhibitors,research,lifescience,medical treated with only HBSS were able to grow after extract exposure. Neutral red staining revealed that the cells were viable after culturing for 24 h. Permeabilization Assay FITC-dextran uptake was observed in the cells that were exposed to this marker in the presence of Inhibitors,research,lifescience,medical 230 ng/mL of streptolysin O. The cells treated with FITC-dextran without permeabilization with streptolysin O were also able to uptake the marker; however, the fluorescence intensity and the number of the cells that showed fluorescence were less Inhibitors,research,lifescience,medical than those in the streptolysin O-treated cells. This

may be related to endocytosis, which took place during the incubation, as has been reported by other researchers.13 The cells were allowed to culture for 24 h. The cells were able to expand and survive, as was indicated by the neutral red assay. Cell Morphology The administration of both 5-aza-dC and TSA reduced cell growth, as was indicated by the number of the passages. Also, 5-aza-dC, when treated alone, had no influence on cell growth. Extensive cell death was Inhibitors,research,lifescience,medical observed with TSA exposure. Although the viable cells were able to proliferate, the confluency was not more than 50%. These chromatin-modifying agents also changed cell morphology. The treated cells were larger than those cultured in the absence of chromatin-modifying agents. The number of processes was reduced, and the cells were polyhedral in shape. More conspicuous morphological modification was observed in the other cell types such as human Inhibitors,research,lifescience,medical granulosa cells and mouse fibroblast cell line (NIH3T3): they became fusiform as a result

of treatment with the chromatin-modifying Carnitine palmitoyltransferase II agents. (Data are not shown.) After extract treatment, more cells showed morphological changes. The cells became elongated and lost their processes. Some multinucleated cells with two or three nuclei were also observed (figure 1). There was no Selleckchem LY2157299 beating cell in the culture with this condition. The cell proliferation rate reduced significantly; however, the cells were viable for at least 30 days. While the cells in the control groups needed to passage every 3 days, the extract treated cells were not confluent even after 30 days from the beginning of the exposure to the cardiomyocyte extract. Figure 1 Cells treated with the extract and chromatin-modifying agents were multinucleated.


To overcome the salt-induced aggregation of CDP/pDNA nanoparticles in physiological media, chemistry was developed to conjugate a neutral stabilizing polymer, PEG, to a hydrophobic small molecule, adamantane (AD), which forms strong inclusion complexes with β-cyclodextrin. In this manner, nanoparticles could be noncovalently stabilized, and this approach was extended to allow incorporation of targeting ligands via preparation of AD-PEG-ligand conjugates

[21, 22]. Utilizing a small interfering RNA (siRNA) targeting Inhibitors,research,lifescience,medical the EWS/Fli1 fusion oncogene and the human transferrin protein as a targeting ligand, the first in vivo proof-of-concept experiments were performed shortly thereafter in a disseminated murine model of Ewing’s sarcoma [23]. The significant antitumor effect demonstrated in this work motivated the creation of a company, Inhibitors,research,lifescience,medical Calando Pharmaceuticals, to further advance this delivery platform (RONDEL) towards therapeutic candidates suitable for clinical evaluation in human cancer patients. The first such candidate, termed CALAA-01, contained an siRNA

targeting the M2 subunit of ribonucleotide reductase (RRM2), a protein involved in DNA replication whose function is required to complete cell division. Upon identification Inhibitors,research,lifescience,medical of the optimal anti-RRM2 siRNA sequence [24] and evaluation of the in vivo nanoparticle performance [25], an IND application was submitted Inhibitors,research,lifescience,medical to the Food and Drug Administration (FDA) and Calando received approval to initiate a phase I trial of CALAA-01 in patients with solid tumors in 2008. In 2010, encouraging interim clinical data from this study was published [26, 27] which revealed, in addition to a promising safety profile and multiple dose escalations, the first evidence of the RNA interference (RNAi) mechanism of action in humans and the first Inhibitors,research,lifescience,medical dose-dependent tumor accumulation in

humans of nanoparticles of any kind upon systemic administration. Figure 3 Timeline of the development of cyclodextrin-containing polymers (CDPs) for PARP inhibitor cancer nucleic acid delivery. In this paper, we describe the development of each of the components of this nucleic acid delivery system. We review the assembly of these nanoparticles, including their physicochemical Sodium butyrate properties and in vivo performance. The development of the CALAA-01 drug product is then discussed, including selection of the gene target and siRNA sequence optimization, safety and efficacy evaluations in animals, and manufacturing/scale-up of the components. The clinical findings of CALAA-01 are then discussed, including characterization of safety parameters (pharmacokinetics (PK), complement activation, cytokine levels, serum chemistry, complete blood counts (CBCs), and adverse events), and efficacy and a discussion of exploratory objectives.

2012], we would suggest all women prescribed antipsychotics with

2012], we would suggest all women prescribed antipsychotics with raised prepregnancy/first trimester BMI should be offered this test. In addition, it would be potentially helpful to consider the creation of an international register to monitor routinely the maternal and foetal outcomes of antipsychotic use in pregnancy [Kulkarni et al. 2008]. GSK343 molecular weight Footnotes Consent: The patient in question has signed an informed consent form allowing publication of the following case report

in any medical journal in print, online and in other licensed versions of the journal. Form available on request. Funding: This research received no specific grant from any funding agency in Inhibitors,research,lifescience,medical the public, commercial, or not-for-profit sectors. Conflict of interest statement: LMH is supported

by the UK Higher Education Funding Council for England. All other authors are employed by the UK National Health Service. LMH has a grant on antipsychotics in Inhibitors,research,lifescience,medical pregnancy from Tommy’s the Baby Charity supported by Johnson and Johnson. DT has provided consultancy to Lundbeck and Inhibitors,research,lifescience,medical Merck, has received honoraria from Eli Lilly, AstraZeneca and Bristol-MyersSquibb, and his institution has received money from Servier and Eli Lilly. SH has received money for consultancy work for LEK consulting. No other authors declared a conflict of interest. Contributor Information Melissa Rowe, Section of Women’s Mental Health, Institute of Psychiatry, King’s College London, UK. Bharath A. Gowda, Department of Neonatology, King’s Inhibitors,research,lifescience,medical College Hospital, London, UK. David Taylor, Institute of Pharmaceutical Science, King’s College London, UK. Simon Hannam, Department of Neonatology, King’s College Hospital, London, UK. Louise M. Howard, Section of Women’s Mental Health, PO31, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
In this issue Elizabeth Penn and Derek Tracy review in great detail the effects of antidepressants in an article headed ‘The drugs don’t work?’. The question mark is important: Penn Inhibitors,research,lifescience,medical and Tracy conclude that drugs

do work but only after a delay and not in everyone. Much of their discussion centres on the now famous analysis of Irving Kirsch who postulated that antidepressants were only really more effective than placebo in the most severe depression [Kirsch et al. 2008]. Of course what is often forgotten is that placebo is itself a potent antidepressant with an effect size (0.92, according to Kirsch) greater than most medical treatments. either In addition to this, Kirsch’s definition of a clinically significant difference is three points on the Hamilton Depression Rating Scale (HDRS). This makes no sense at all because the HDRS is an ordinal scale: someone with a score of 20 is not twice as depressed as someone with a score of 10. Moreover, a three-point difference on the suicide item of the HRDS is a very different thing from a difference of three points on sleep items.

29 The likelihood of finding an antidepressant, effect, was highe

29 The likelihood of finding an antidepressant, effect, was higher in studies with low placebo response, consistent with findings in antidepressant trials

in depressed selleck chemicals llc patients without, substance use disorders. The authors concluded that antidepressants can be useful in these patients if used in adequate doses and for an adequate length of time (at least 6 weeks). The overall effect size they found was 0.38, which is comparable with the effect Inhibitors,research,lifescience,medical size, 0.43, found in a meta-analysis of antidepressant trials in depressed outpatients.30 Only a few studies examined depressed patients with and without comorbid substance-use disorder. One older study found alcohol use to be a predictor of nonresponse Inhibitors,research,lifescience,medical in depressed patients.31 In STAR*D, about 20% of

depressed patients fulfilled criteria of drug or alcohol abuse or dependence and presence of these disorders impaired remission during monotherapy with citalopram.7 In summary, there is some evidence to suggest that a comorbid substance use disorder impairs Inhibitors,research,lifescience,medical remission in depressed patients. With regard to treatment, recommendations in patients with substance abuse and comorbid depression, a recent, thorough review32 concluded that there is a clear pattern of benefit in favor of antidepressant drug treatment for patients who have co-occurring major depression Inhibitors,research,lifescience,medical and substance use disorders. Somatic comorbidity Clinical trials of antidepressants usually exclude patients with medical comorbidity; however, depression with medical comorbidity is the norm rather than the exception among patients who are seen in most, clinical settings. Recently, the WHO World Health Survey with 245 404

participants from 60 countries from all regions of the world, showed that, an average of between 9% and 23% of participants with one or more chronic physical disease had comorbid depression.1 This result was significantly higher than the likelihood of Inhibitors,research,lifescience,medical having depression in the absence of a chronic physical disease.1 Depression produced the greatest decrement, in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. Before the introduction of selective serotonin reuptake inhibitors (SSRIs), treatment of depression much in the medically ill was difficult, due to many contraindications for the use of tricyclic antidepressants in medically ill depressed patients. One study trying to recruit medically ill patients with depression to a study with nortriptyline was halted at the midpoint, because of inadequate patient recruitment, primarily a consequence of medical illnesses that prevented more than 80% of eligible patients from participating in or completing the clinical trial. Major or minor medical contraindications to the use of antidepressants were present in over 90% of depressed patients.