The Pharmacotherapy of Depressive Illness in Adolescence: III. Diagnostic and Conceptual Issues in Studies of Tricyclic Antidepressants

1992 ◽  
Vol 2 (1) ◽  
pp. 23-29 ◽  
Author(s):  
MICHAEL STROBER
Keyword(s):  
Tricyclic Antidepressants ◽  
Depressive Illness

Antidepressants in Cancer Pain

1991 ◽  
Vol 7 (4) ◽  
pp. 42-44 ◽  
Author(s):  
Alberto E. Panerai ◽  
Mauro Bianchi ◽  
Paola Sacerdote ◽  
Carla Ripamonti ◽  
Vittorio Ventafridda ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Cancer Pain ◽  
Beneficial Effect ◽  
Nerve Injury ◽  
Analgesic Effect ◽  
Tricyclic Antidepressants ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Morphine Analgesia

Studies conducted in recent years have helped define the role of antidepressant drugs in the management of cancer pain. The anti-nociceptive action of these agents seems to be independent of beneficial effect on depression or mood. Among antidepressant drugs, those of the tricyclic class are preferred when an analgesic effect is sought. Their primary application is for pain due to nerve injury, so-called “neuropathic pain”. Although the co-administration of tricyclic antidepressants may increase plasma morphine concentrations, any potentiation of morphine analgesia is thought not to be due to an increased bioavailability of the opiate, but to an intrinsic analgesic effect of antidepressants. On this basis, the use of antidepressants in combination with opioids for the treatment of cancer pain is suitable when a component of deafferentation is present or when there is concomitant depressive illness.

The Benefits and Risks of 5-HT Uptake Inhibitors in Depression: Chairman's Introduction

1988 ◽  
Vol 153 (S3) ◽  
pp. 7-10 ◽  
Author(s):  
Stuart A. Montgomery
Keyword(s):  
Tricyclic Antidepressants ◽  
Recent Trend ◽  
Epidemiological Studies ◽  
Depressive Illness ◽  
Important Goal ◽  
Men And Women ◽  
Normal Populations ◽  
Prevalence Of Depression ◽  
5 Ht Uptake ◽  
Substantial Morbidity

Depression is unfortunately a very common illness; it is extremely unpleasant for sufferers and for their relatives and friends, and is associated with a substantial morbidity and mortality. The lifetime risk of developing depression was estimated by Boyd & Weissman (1981) as between 8% and 12% for men and between 20% and 26% for women. Estimates of point-prevalence vary, but a review of published studies suggests a level of 8.4% for men and 14.8% for women. A difference in prevalence of depression between men and women, with a twofold increase in women, appears to be well established. Recent evidence suggests, however, that the incidence of depression in men is rather more common than was previously thought: some apparent sex differences in frequency may be accounted for by a difference in coping with, and expression of, depressive symptoms (Angst & Dobler-Mikola, 1984). What is clear from the epidemiological studies in ‘normal’ populations is that much depressive illness remains untreated.All existing treatments for depression, in particular the tricyclic antidepressants (TCAs), have drawbacks. Since the TCAs, for example, are associated with rather unpleasant and sometimes dangerous side-effects, which reduce compliance and compromise treatment, the search for new antidepressants with less unwanted effects and if possible greater efficacy remains an important goal. A recent trend in antidepressant research has been to develop compounds with specific pharmacological actions, which are selective for one of the amine systems. Currently, a number of specific 5-HT reuptake inhibitors are being developed, and some of these are now in clinical use.

Serum dihydrobiopterin levels in patients on tricyclic antidepressants

1982 ◽  
Vol 12 (1) ◽  
pp. 191-192 ◽  
Author(s):  
R. J. Leeming ◽  
J. A. Blair ◽  
J. Walters
Keyword(s):  
Tricyclic Antidepressants ◽  
Serum Levels ◽  
Depressive Illness ◽  
Female Patients

SynopsisSerum levels of 7, 8-dihydrobiopterin were significantly raised in female patients with depressive illness who were being treated with tricyclic antidepressants.

CONTINUATION THERAPY WITH TRICYCLIC ANTIDEPRESSANTS IN DEPRESSIVE ILLNESS

The Lancet ◽  
1972 ◽  
Vol 300 (7782) ◽  
pp. 854-855 ◽  
Author(s):  
R.H.S Mindham ◽  
C Howland ◽  
Michael Shepherd
Keyword(s):  
Tricyclic Antidepressants ◽  
Depressive Illness ◽  
Continuation Therapy

Beyond the monoamine hypothesis: mechanisms, molecules and methods

2002 ◽  
Vol 17 (S3) ◽  
pp. 294s-299s ◽  
Author(s):  
I. Hindmarch
Keyword(s):  
Tricyclic Antidepressants ◽  
Rating Scales ◽  
Stress Disorder ◽  
Antidepressant Drugs ◽  
Antidepressant Activity ◽  
Hippocampal Volume ◽  
Depressive Illness ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Noradrenaline Levels

SummaryThe first effective antidepressants (monoamine oxidase inhibitors and tricyclic antidepressants) relied on their ability to augment serotonin and noradrenaline levels at the synapse. Forty years later, the same biological model led to the supremacy of the serotonergic hypothesis to explain not only the pathophysiology of depressive illness, but also the neuropharmacological basis for obsessive compulsive disorder, phobias, posttraumatic stress disorder, and even generalized anxiety disorder. It could be argued that the blinkered view of depression as a solely serotonergic phenomenon has not only restrained and limited research into other potential systems, but has also slowed down the discovery of putative antidepressant drugs. While some might argue that the hypothalamic-pituitary-adrenal (HPA) axis explains an individual’s sensitivity to depression, there are others who equally claim that the most likely explanations are to be found in the neuropsychopharmacology of the immune system or even through reductions in hippocampal volume. There is a richness of possibilities regarding the mechanisms for antidepressant activity embracing theoretical, pharmacological and clinical data. However, the methods by which putative antidepressants are assessed and their clinical efficacy demonstrated are not always robust. That current clinical comparisons of antidepressants rarely show major differences in efficacy between existing molecules could be taken as an indication that “all drugs are the same” or perhaps, more insightfully, as an indication that the ubiquitous Hamilton depression (HAM-D) rating scales are not sensitive to inter-drug differences, even though pronounced pharmacodynamic differences between molecules are easily demonstrated. Any advances in the development of new antidepressants will have to find not only original compounds but also unique psychometric tests by which the drugs can be assessed in a sensitive, reliable, and valid manner.

Rating Scales as Predictors of Response to Tricyclic Antidepressants

1976 ◽  
Vol 10 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Graham D. Burrows ◽  
George Foenander ◽  
Brian Davies ◽  
Bruce A. Scoggins
Keyword(s):  
Tricyclic Antidepressants ◽  
Rating Scales ◽  
Rating Scale ◽  
Depressive Illness ◽  
Predictors Of Response ◽  
Significant Difference ◽  
Scale Scores ◽  
Nortriptyline Hydrochloride ◽  
Hamilton Rating Scale ◽  
Predict Treatment Response

Fifty-three patients suffering from depressive illness were classified as ‘responders’ or ‘non-responders’ on the basis of an “amelioration score” of the Hamilton Rating Scale for depression after six weeks treatment with nortriptyline hydrochloride at 150 mgs. daily. A multivariate analysis of variance was performed on the four psychological rating scale scores used, to determine whether rating scales could predict treatment response to tricyclic antidepressants. There was a significant difference between the two groups after adjustment for age. Subjects were then classified as ‘non-responders’ and ‘responders’ on the basis of their discriminant scores. The prediction of response to tricyclic antidepressants was found to be at 75% probability.

Trial of a Sustained Release Form of Amitriptyline in the Treatment of Depressive Illness

1972 ◽  
Vol 120 (554) ◽  
pp. 65-67 ◽  
Author(s):  
A. C. P. Sims
Keyword(s):  
Failure Rate ◽  
Tricyclic Antidepressants ◽  
Psychiatric Patients ◽  
Depressive Illness ◽  
Single Daily Dose ◽  
High Failure Rate ◽  
Double Blind ◽  
Daily Dose ◽  
Release Form ◽  
Patient Studies

Amitriptyline is a widely used antidepressant and its effectiveness has been shown, e.g. in comparison with imipramine in double blind trial (Burt et al., 1962; Hordern et al., 1963, 1964). A disadvantage of currently prescribed tricyclic antidepressants is the necessity for administering the drug three times a day. It has been shown that general medical and in particular psychiatric patients fail to take their medication either in the prescribed dose or at all (Benstead and Theobald, 1952; Haler, 1952; Park and Lipman, 1964; Parkes et al., 1962; Porter, 1969). This failure rate may be as high as 50 per cent (Dixon et al., 1957; Willcox et al., 1965). Even in psychiatric in-patient studies there was still a high failure rate in taking prescribed psychiatric drugs (Hare and Willcox, 1967). A regimen consisting of a single daily dose is more reliably taken than one consisting of thrice daily dosage (Coppen et al., 1969; General Practitioner Clinical Trial 1970).

Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants in Combination

1995 ◽  
Vol 167 (5) ◽  
pp. 575-580 ◽  
Author(s):  
David Taylor
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Serum Levels ◽  
Depressive Illness ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Refractory Depression ◽  
Reference Sections ◽  
Literature Evidence

BackgroundThe selective serotonin reuptake inhibitors (SSRIs) are now widely used in the treatment of depressive illness. Interest has grown in the use of SSRIs as alternatives to tricyclic antidepressants (TCAs) and in the therapeutic use of combinations of SSRIs and TCAs in refractory depression.MethodMEDLINE and PSYCLit literature searches were conducted. Reference sections from papers retrieved were scrutinised for other relevant reports.ResultsOf 41 relevant articles identified, 35 were selected for review.ConclusionsFluoxetine, fluvoxamine, paroxetine and sertraline may substantially increase TCA plasma levels when given concurrently. Such interactions may give rise to adverse effects. The effect of sertraline may be less profound than that of fluoxetine, fluvoxamine and paroxetine. Limited data suggest that citalopram may not affect TCA serum levels. There is scant literature evidence to support the use of SSRIs in combination with TCAs as a treatment for refractory depression.

Fluoxetine vs Amitriptyline in the Treatment of Depressed Out-patients

1988 ◽  
Vol 153 (S3) ◽  
pp. 64-68 ◽  
Author(s):  
G. Laakmann ◽  
D. Blaschke ◽  
R. Engel ◽  
A. Schwarz
Keyword(s):  
Adverse Effects ◽  
Depressive Disorder ◽  
Serotonin Reuptake ◽  
Tricyclic Antidepressants ◽  
Depressive Illness ◽  
Double Blind ◽  
Benzodiazepine Derivatives ◽  
Blind Comparison ◽  
Depressive Syndromes ◽  
Therapeutic Possibilities

As a result of research in recent years, therapeutic possibilities for the treatment of depressive illnesses have been significantly expanded. Monoamine oxidase inhibitors and selective noradrenaline (e.g. oxaprotiline) or serotonin-reuptake inhibiting (e.g. fluoxetine, fluvoxamine) substances have been added to the classical tricyclic antidepressants, whose mode of action is primarily based upon combined noradrenaline and serotonin reuptake inhibition. Furthermore, the extent to which benzodiazepine derivatives or neuroleptics can be successfully used at low dosages for the treatment of depressive illness is currently being investigated.For these compounds to be used in an individualised manner, however, agreed diagnostic criteria must be taken into consideration, as well as other factors such as the severity and type of depressive syndrome (mild, marked, or severe, retarded or agitated). For example, the benzodiazepine derivative alprazolam has a therapeutic efficacy comparable to amitriptyline for the treatment of milder depressive syndromes, but is significantly less effective for a severe depressive disorder.We undertook a study of fluoxetine, a selective serotonin-reuptake inhibitor (Wong et al, 1974, 1975), in a double-blind comparison with amitriptyline. We particularly wanted to know if the efficacy of fluoxetine was comparable to that of amitriptyline, and whether fluoxetine caused less adverse effects as a result of its selectivity, which remains unchanged even after its metabolisation to desmethyl fluoxetine (Fuller et al, 1978).

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