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                  <text>"Mm-"-

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“www.mw, we“. ”aur.:g2;qusm;

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November 12. 1970

mnmv-w—Vm

mem

7

Dr. Allen Rankin
Research Psychologist
Psychopharmacology Research Branch
National Institute of Mental Health
5454 Wisconsin Avenue
Chevy Chase, Maryland 20015

Ya

qr

.FWy—v—

Dear Allen,

for the opportunity to read your report on
depression subtypes. Taken together with Jonathan's heroic
effort to be optimistic about the variety of new studies,
your study indicates clearly that the present antidepressant
drugs are an unsatisfactory answer to depressive illness.
In part, this was presaged when, in reviewing the neuro-~
physiology of different psychoactive drug groups for the
ACNP in 1968, I found four drug classes with four different
neurophysiology patterns a reflection that no one treatment
Thank you

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.,

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,1...

_

A

_—..

—

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was

satisfactory.

.

Vx-wn'rnwv~

.w

.4
..

.0.

a

,ivﬂ-

warm-”v...“

”Wm

The reawakened

interest in

1966-67

in unilateral electrode

in multiple treatments in convulsive therapy led me
to reopen my studies of ECT, and we have made some interesting
observations. It is possible to effectively treat depressive
or
patients (of any age) within 3-5 days, without measurable
made
by
possible
is
Such
treatment
rapid
clinical memory loss.
seizure
of
and
rate
oxygenation
placement,
changes in electrode
induction.
that ECT is the primary treatment for a
It is apparent
and
that drug treatments may be most useful
depressive state,
regimens.
and
maintenance
as adjuvants

placement and

- ECT comparisons are probably useful in
the combinations
delineating the relative dosages of each, andThis
"radical" view
Imipramine

most

suitable for each depression subtype.
the initial startle reaction
it, despite
needing answers are two:
questions
specific

has much to commend
may excite. The

it

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Dr. Raskin

November 12, 1970

-2—

(1)

For each of the

psychotic, schizophrenia), is

3

ECT

depressive subtypes, (neurotic,
equally useful?

(2) To what extent is a supplementary drug therapy
necessary for each subtype; and which ”antidepressant" drug is
most useful?
A direct comparison of EC? and imipraminc should confirm
the superiority of imipramine, as the Greenhlatt-Grosaer and
Shepherd~NRC studies showed. (There are 5 other studies quoted
by Klein and Davis showing ECT equal or better than imipramine.)
Perhaps, the typology and predictor approach is more useful new.

We

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-

y”

Mandela

have tried to confirm the Carney, the Robson and the
predictor scores in our recent ECT study and were

unsuccessful.

is our latest report as sent to the Archives. I
of the active ECT workers, and I look forward to discussing
this work with you in Puerto Rico.
Enclosed

know many

.-—

Again, thanks for the preprint.

.m.

wry».

Sincerely yours,
‘Wv-Fm-Mn

Max

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mr’

-

:WﬂvT'WTW’WJrV-‘WW_Z~UWMM~

r-u

Fink gen.

Professor of Psychiatry

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811C 0

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