Continuation Therapy with Tricyclic Antidepressants in Relapsing Depressive Illness

2015 ◽  
pp. 49-55
Author(s):  
R. H. S. Mindham
Keyword(s):  
Tricyclic Antidepressants ◽  
Depressive Illness ◽  
Continuation Therapy

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

Continuation Therapy with Amitriptyline in Depression

1978 ◽  
Vol 133 (1) ◽  
pp. 28-33 ◽  
Author(s):  
A. Coppen ◽  
K. Ghose ◽  
S. Montgomery ◽  
V. A. Rama Rao ◽  
J. Bailey ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Plasma Concentrations ◽  
Antidepressant Medication ◽  
Depressive Illness ◽  
Continuation Therapy ◽  
One Year ◽  
To Receive

SummaryThirty-two patients who had responded to amitriptyline (150 mg daily) when suffering from a depressive illness were allocated either to receive placebo or to remain on the same medication for one year.Plasma concentrations of the drug were regularly estimated. There was no correlation between plasma concentration and subsequent residual affective morbidity. In spite of considerable encouragement, three of the patients did not take the prescribed amitriptyline and they all relapsed. Five out of sixteen patients who received placebo relapsed. None of the patients who continued to take amitriptyline relapsed.It is emphasized that the patients studied were selected, inasmuch as they were apparent responders to amitriptyline. It is concluded that this group of patients should continue to be treated with antidepressant medication for eight months after apparent recovery, and care should be taken to ensure the patients' compliance.

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.

An evaluation of continuation therapy with tricyclic antidepressants in depressive illness

1973 ◽  
Vol 3 (1) ◽  
pp. 5-17 ◽  
Author(s):  
R. H. S. Mindham ◽  
C. Howland ◽  
Michael Shepherd
Keyword(s):  
Antidepressant Medication ◽  
Complete Recovery ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Trial Period ◽  
Double Blind ◽  
Residual Symptoms ◽  
Continuation Therapy ◽  
Double Blind Clinical Trial ◽  
Lower Dose Level

SynopsisA double-blind clinical trial has been carried out to ascertain whether patients making a good recovery from depressive illness with tricyclic antidepressant medication derive any benefit from continuation of therapy with the same drug at a lower dose level. Of the 92 patients who entered the trial significantly fewer on active treatment relapsed during the six-month trial period: 22% as compared with 50% of patients receiving placebo. Patients with residual symptoms on entry to the trial derived more benefit from continuation therapy than patients who had made a complete recovery. The findings relate to a six-month trial period only, and any possible advantage of continuation therapy over a longer period remains uncertain.

Continuation therapy with lithium and amitriptyline in unipolar depressive illness: a controlled clinical trial

1981 ◽  
Vol 11 (2) ◽  
pp. 409-416 ◽  
Keyword(s):  
Clinical Trial ◽  
Depressive Illness ◽  
Controlled Clinical Trial ◽  
Comparative Efficacy ◽  
Continuation Therapy ◽  
Relapse Rates

SynopsisAn account is given of a multi-centre, controlled clinical trial of the comparative efficacy of lithium, amitriptyline and placebo in terms of the comparative relapse-rates over a three-year period among patients who had recovered from a depressive illness. The results indicate that while both the pharmacodynamically active drugs are more effective than placebo the differences between them are minimal.

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.

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.

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