Amitriptyline and depression

Topiramate may affect alcohol, amitriptyline, CNS depressants, lithium, oral contraceptives, digoxin, estrogens, hydantoins, metformin, risperidone, and valproic acid. 

In 1995, Bramble published a study on the prescription frequency of antidepressants by British child psychiatrists (Bramble, 1995). A brief postal questionnaire was circulated to 350 members of the British Royal College of Psychiatrists, Child and Adolescent Psychiatry Specialist Sections. There was a 71% response rate, and 85% of the 238 respondents had employed antidepressants, the most popular of these being amitriptyline and imipramine. Nearly one-third of the psychiatrists at that time used neuroagents occasionally, and the SSRIs were used only very rarely. The antidepressant medication was used for a wide range of child and adolescent disorders beyond those of depression and nocturnal enuresis. Approximately 20% of the prescriptions were given for ADHD (hyperkinetic disorder), conduct disorder, and a few cases of autistic disorder. Clomipramine was apparently given for OCD. On the basis of these 1994 data. Bramble concluded that British child psychiatrists tend to use antidepressant medication far less often than American psychiatrists. 

Coppen A, Ghose K, Montgomery S, et al Continuation therapy with amitriptyline in depression. Br J Psychiatry 133 28-33, 1978 Coppen A, Swade C, Wood K Lithium restores abnormal platelet 5-HT transport in patients with affective disorders. Br J Psychiatry 136 235-238, 1980 Coppen A, Swade C, Jones SA, et al Depression and tetrahydrobiopterin the folate connection. J Affect Disord 16 103-107, 1989 Cordell B 3-Amyloid formation as a potential therapeutic target for Alzheimer s disease. Annu Rev Pharmacol Toxicol 34 69-89, 1994 Corkin S Acetylcholine, aging, and Alzheimer s disease imphcations of treatment. Trends Neurosci 4 287-290, 1981... 

Kupfer DJ, Spiker DG, Coble P, et al Amitriptyline and EEG sleep in depressed patients, 1 drug effects. Sleep 1 149-159, 1978... 

Bremner JD A double-blind comparison of Org 3770, amitriptyline, and placebo in major depression. J Clin Psychiatry 56 519-525, 1995... 

The approval of mirtazapine in the United States was based on six double-blind, placebo- and amitriptyline-controlled studies in which it was found to be superior to placebo and comparable with amitriptyline in terms of antidepressant efficacy (173,174). In a double-blind, crossover study, 63% of patients who failed to respond to 6 weeks of double-blind treatment with amitriptyline responded to mirtazapine (175). In two studies, mirtazapine was found to be efficacious in the treatment of patients hospitalized for major depression. In the first study, the antidepressant efficacy of mirtazapine was comparable with that of amitriptyline and superior to placebo (176). In the other study, the antidepressant efficacy was superior to that of fluoxetine (118). There are advantages and disadvantages to mirtazapine, including the following ... 

Hordern A, Holt NF, Burt CG, et al. Amitriptyline in depressive states phenomenology and prognostic considerations. Br J Psychiatry 1963 109 815-825. 

Rickels K, Gordon PE, Weiss CC, et al. Amitriptyline and trimipramine in neurotic depressed patients a collaborative study. Am J Psychiatry 1970 127 208-218. 

Catterson M, Preskorn SH. Double-blind crossover study of mirtazapine, amitriptyline, and placebo in patients with major depression. In New Research Program and Abstracts of the 149th annual meeting of the American Psychiatric Association, New York, May 6, 1996 NR157. 

Hicks F, Robins E, Murphy G. Comparison of adinazolam, amitriptyline, and placebo in the treatment of melancholic depression. Psychiatry Res 1987 23 221-227. 

Kay DWK, Fahy Y, Garside RF. A seven-month double-blind trial of amitriptyline and diazepam in ECT-treated depressed patients. Br J Psychiatry 1970 117 667-671. 

Soloff et al. (245) compared haloperidol, amitriptyline, and placebo in 61 patients and found the neuroleptic clearly superior to amitriptyline or placebo, particularly for psychotic symptoms. The study is particularly noteworthy in that the sample size is reasonably large, with approximately 28 in each group. Although haloperidol benefited psychotic symptoms (e.g., paranoid ideation, psychoticism), general severity, and depression, it also improved depressive symptoms, as did amitriptyline. 

In the past, tricyclic drugs such as amitriptyline and nortriptyline were the most commonly used antidepressants and were the standard against which other antidepressants were measured.30 The use of tricyclic drugs as the initial treatment of depression has diminished somewhat in favor of some of the newer second-generation drugs, which may have more favorable side-effect profiles. Tricyclic agents, nonetheless, remain an important component in the management of depressive disorders, especially in more severe forms of depression that fail to respond to other antidepressants.6,53... 

The barbiturates and meprobamate have been entirely superseded by the benzodiazepines and because of their low benefit-to-risk ratio (dependence producing, lethality in overdose, potent sedative effects) they should never be used as anxiolytics. Despite their popularity as short-term sedatives, antihistamines are ineffective anxiolytics, while the use of sedative antidepressants such as amitriptyline should be limited to the treatment of patients with symptoms of both anxiety and depression due to their limited efficacy and the poor patient compliance associated with their adverse effects. However, patients with panic disorder do appear to show a beneficial response to antidepressants (see Chapter 6). A similar argument... 

An unpublished document obtained during discovery in product liability suits against the drug company disclosed that Eli Lilly, the manufacturer of fluoxetine (Prozac), had evaluated the comparative rates of suicide attempts on fluoxetine, amitriptyline, and placebo (the documents are available from http //www.breggin.com). The data were generated during controlled clinical trials conducted for the FDA approval process for Prozac for depression. On the basis of the company s data for controlled clinical trials, patients taking fluoxetine were 12 times more... 

Kaumeier HS, Haase HJ. A double-blind comparison between amoxapine and amitriptyline in depressed inpatients. Int J Clin Pharmacol Ther Toxicol 1980 18(4) 177-84. 

Rosenfeld H, Whalen EM. Clomipramine and amitriptyline in depressed outpatients. A controlled study. 

Francesconi G, LoCascio A, Medina S, et al. Controlled comparison of melitracen and amitriptyline in depressed patients. Curr Ther Res Clin Exp 1976 20 529. 

In a multicenter comparison of moclobemide, amitriptyline, and placebo, gastrointestinal discomfort, headache, and dizziness occurred in over 20% of moclobemide-treated patients insomnia was also common (10). In healthy volunteers there were no effects of moclobemide on psychomotor performance. Acute confusion and agitation was reported in one patient who dropped out of a clinical trial owing to this adverse effect (SEDA-16, 7). Hypomania was attributed to moclobemide in two cases (SEDA-17, 16). Aggressive behavior and mild manic symptoms were described in severely depressed patients, refractory to other treatments, who took moclobemide (SEDA-18, 15). 

Bakish D, Bradwejn J, Nair N, McClure J, Remick R, Bulger L. A comparison of moclobemide, amitriptyline and placebo in depression a Canadian multicentre study. Psychopharmacology (Berl) 1992 106(Suppl) S98-S101. 

Herrington RN, Bruce A, Johnstone EC, Lader MH. Comparative trial of L-tryptophan and amitriptyline in depressive illness. Psychol Med 1976 6(4) 673-8. 

A double-blind study in which 31 patients with breakthrough depression taking lithium received augmentation with either paroxetine or amitriptyline and showed a quantitative increase in tremor activity with combined therapy, but no significant change in tremor frequency (214). 

In 62 patients with co-existing psychotic and depressive symptoms, risperidone (mean dose 6.9 mg/day) was compared with a combination of haloperidol 9 mg/day and amitriptyline 180 mg/day (n = 61) in a multicenter, randomized, double-blind study over 6 weeks (69). The results suggested that haloperidol plus amitriptyline was... 

Muller-Siecheneder F, Muller MJ, Hillert A, Szegedi A, Wetzel H, Benkert O. Risperidone versus haloperidol and amitriptyline in the treatment of patients with a combined psychotic and depressive syndrome. J Clin Psychopharmacol 1998 18(2) 111-20. 

Martinowich K, Manji H, Bai L. New insights into BDNF function in depression and anxiety. Nature Neurosci. 2007 10 1089-1093. Kolia N, Wei Z, Richardson JS, Li XM. Amitriptyline and fluoxetine protect PC12 cells from cell death induced by hydrogen peroxide. J. Psychiatry Neurosci. 2005 30 196-201. 

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