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Although depression secondary to medical illness occurs frequently, little is known about its response to conventional antidepressant therapy. In this retrospective study of 50 patients, the authors assessed the charted therapeutic effect of antidepressants and sought to define pretreatment features associated with good outcome. Half (9/18) of the patients with a previous history of depression improved while only 22% (7/32) of the patients without a previous history of depression showed improvement in mood. Those patients meeting DSM-III criteria for major depressive disorder were no more likely to benefit from antidepressants than were patients meeting criteria for adjustment disorder with depressed mood. The authors conclude that previous history of depression should be considered when assessing risks and benefits for antidepressants for medically ill patients with depressive syndromes.

Background Evaluation of ethanol use before and after liver transplantation is presently hindered by the limited detection period of ethanol itself, a lack of other proven markers, and reliance on patients9 verbal history. Fatty acid ethyl esters (FAEEs) are direct metabolites of ethanol that persist at least 48 hours in blood after drinking and have been used as ethanol biomarkers. Fatty acids, a substrate for FAEE synthesis, are affected by immunosuppressive medications. Low levels of ethanol, from endogenous intestinal fermentation or mouthwash, could potentially lead to spuriously increased FAEE levels in the setting of lipid-increasing immunosuppresion. Our FAEE assay detected all three predominant FAEEs (ethyl palmitate, ethyl oleate, and ethyl stearate) in all 76 samples from recently drinking individuals. We assessed whether FAEEs are detectable in plasma samples from abstinent liver transplant recipients. Methods Thirty-five plasma samples from 30 abstinent liver transplant recipients (M:F 19:11) were analyzed; abstinence was confirmed by the Timeline Followback instrument and breath ethanol analysis. Levels of ethyl palmitate, ethyl oleate, and ethyl stearate were measured by gas chromatography-mass spectrometry after lipid extraction and solid phase extraction of the samples. Ions 88.1 and 101.1 were monitored. Results At the time of sampling, immunosuppressive regimens included tacrolimus in 26, sirolimus in 21, prednisone in 8, cyclosporine in 8, and mycophenolate mofetil in 6 participants. Regimens included 1, 2, and 3 immunosuppressants in 6, 22, and 6 of the participants, respectively. FAEE levels above the lower limit of quantitation, 60 nM, were not found in any participant. Twenty-two samples had no measurable FAEE and 13 had trace levels, 2-38 nM, which are not distinguishable from instrument contamination due to previous FAEE-containing samples. In all the samples with trace amounts, only one of three FAEEs was present. Conclusion There were no false-positive FAEE assays in this cohort of abstinent post liver transplant recipients, regardless of immunosuppressive treatment. FAEE monitoring in a low-dose ethanol consumption experiment is the next step in validation of this promising method of ethanol use detection in this population.

Purpose Blood Alcohol Levels (BAL) correlate with alcohol intoxication and tolerance. In this study we correlated concentrations of Fatty Acid Ethyl Esters (FAEEs) with BAL and examined the effects of gender and age. Methods This study was approved by the Colorado Multiple Institutional Review Board for monitoring of human research. Samples for inclusion in this study were identified by positive BAL. Samples positive for BAL (N=48, men=38, women=10) were labeled with years of age, BAL and gender (without patient identifiers) and analyzed for FAEEs by gas chromatography-mass spectrometry (GC-MS). Results All forty-eight samples with positive BAL had measurable FAEE levels. BAL correlated with individual FAEEs (ethyl palmitate, ethyl oleate, and ethyl stearate, Spearman9s rank r=0.73-0.77, p≤0.001) and total FAEEs (Spearman9s rank r=0.77, p≤0.001). Patients with BAL≥100 mg/dL (intoxicated) or BAL≥200 mg/dL (tolerant) had total FAEE concentration greater than 3000 nM (Fisher9s exact: 4.38, p≤0.0001 and 4.75, p≤0.00001, respectively). Mean BAL was not significantly different by gender (218.68±114.32 mg/dL for men, 174.9±113.90 mg/dL for women, p=0.29). Total FAEE concentration was 8513.1±5999.1 nM for men and 4880.8±4259.5 nM for women. Controlling for blood ethanol levels and age in an ANCOVA on the rank transformation of total FAEEs, gender was not a statistically significant covariate (p=0.12). Divided into two groups by median age (43.5 years), total FAEE concentration was 9591.9±5772.5 nM for the younger group and 5920.9±5402.3 nM for the older group. Mean BAL was significantly different by age (245.21±96.832 mg/dL for the younger group, 173.92±121.39 mg/dL for the older group, p=.01). Controlling for blood ethanol levels and gender in an ANCOVA on the rank transformation of total FAEEs, age was not a statistically significant covariate (p=0.07). Conclusion The strong correlations between BAL and FAEE levels confirm the utility of plasma FAEE levels as an indication of BAL. In addition, plasma FAEE levels greater than 3000 nM correlated with BAL consistent with intoxication and tolerance. Our analysis failed to demonstrate a significant relationship between gender or age and FAEE levels.