Stress, Depression and Genomic Change

Haloperidol decafloate (HPL-D) is a useful depot neuroleptic on several counts : it has a duration of action of 4-6 weeks, there is no dumping effect associated with its administration, and the adverse effects milligram for milligram are fewer and milder than those observed with the oral form of haloperidol (Beresford and Ward, 1987, Glazer and Kane, 1992). HPL-D requires to be administered by deep intramuscular injection; subcutaneous administration may be associated with the development of injection site reactions (Hamann et al., 1990). In low doses, intramuscular administration into the deltoid is feasible and convenient. In high doses, however, the larger volume of drug to be administered necessitates injection into the gluteus. This is where the problem arises. Disposable syringes in India usually have an approximately one inch needle length. Disposable 21 gauge needles, required for use with HPL-D, are generally of the same length. Consttutional and behavioural factors, more in women than in men, usually result in the presence of gluteal fat that is over an inch or two in thickness in the average Indian patient. In consequence , it is likely that despite gluteal compression during injection, few Indian patients truly receive deep intramuscular HPL-D when the drug is injected into the buttock, in fact, it is possible that many patients are actually receiving the injection in subcu-taneous fat. No reports of injection site reaction with HPL-D have appeared in the Indian scientific press. Is this because of under-reporting or might subcuta-neous HPL-D be less harmful than earlier believed ? REFERENCES Beresford, R. & Ward, A. (1987) Haloperi-dol decanoate : A preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in psychosis. Drugs, 33, 31-49. (1992) Depot neuroleptic therapy : an underutilized treatment option. (1990) Injection site reactions after intramuscular administration of haloperidol decanoate. Deregulation of hypothalamo-pituitary ad-renal axis (HPA) is one of the oldest and most consistent findings in depression. It is now generally accepted that stressful life events and chronic difficulties can trigger the onset of depression in pre-disposed individuals. Enough is known about the central control of HPA function and its response to stress in the neurobiology of triggering the depression. The stress induces hypercortisolaemia which triggers depression by inducing genomic change. There are two types of corticoid receptors in brain tissue-type I and type II receptors (Reul & De Kloet, 1986). Under basal conditions Cortisol has very high affinity with 80% occupancy …