Amitriptyline in depression

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... 

J Clin Psychiatry 53 [suppl 10) 8-27, 1992 Harris B, Szulecka TK, Anstee JA Fluvoxamine versus amitriptyline in depressed hospital outpatients a multicentre double-blind comparison trial. British Journal of Clinical Research 2 81-88, 1991... 

Burt CG, Gordon WF, Holt NF, et al. Amitriptyline in depressive states a controlled trial. J Ment Sci 1962 108 711-730. 

Grof P, Saxena B, Cantor R, et al. Doxepin versus amitriptyline in depression a sequential double-blind study. Curr Ther Res 1974 16 470-476. 

Stuppaeck CH, Geretsegger C, Whitworth AB, et al. A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients. J Clin Psychopharmacol 1994 14 241-246. 

Rush AJ, Erman MK, Schlesser MA, et al. Alprazolam vs. amitriptyline in depressions with reduced REM latencies. Arch Gen Psychiatry 1985 42 1154-1159. 

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. 

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. 

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MAPI - There was renewed interest in MAOI since their combination with TCA may be the only alternative to the use of EOT for drug-resistant patients.91 EOT was superior to combined phenelzine and amitriptyline in severe depression,92 but phenelzine alone was as effective as amitriptyline in depressed outpatients.93 Caroxazone, an effective antidepressant drug (29), probably acts through reversible inhibition of the two known forms of IfAO (A and B). ... 

Bolter, P. A. (1975) A clinical double-blind comparison of maprotiline and amitriptyline in depression. Curr. med. Res Opin., 3, 634. 

Chen, L. X., Wang, Z. G., Ai, M. et al. (2005). Effect of CYP2C19 genotypes on demethylation of amitriptyline in Chinese patients with depression. Chinese Journal of Nervous and Mental Diseases, 31(1), 33-6. 

Versiani, M., Ontiveros, A., Mazzotti, G., Ospina, J. et al. (1999). Fluoxetine versus amitriptyline in the treatment of major depression with associated anxiety (anxious depression) a doubleblind comparison. Int. Clin. Psychopharmacol, 14, 321-7. 

Apart from the antidepressant effect, acute effects occur that are evident also in healthy individuals. These vary in degree among individual substances and thus provide a rationale for differentiated clinical use (p. 233), based upon the divergent patterns of interference with amine transmitters/modula-tors. Amitriptyline exerts anxiolytic, sedative and psychomotor dampening effects. These are useful in depressive patients who are anxious and agitated. 

Sovner et al. (1998) have done an excellent job summarizing the data on antidepressants in patients with developmental disabilities. There have been nine reports of antidepressant use in adults with depression and MR and three reports of antidepressant use in children and adolescents. Eight of nine reports in adults were positive. The drugs studied included nialimide (n = 27), fluoxetine (9), imipramine (6), amoxapine (2), and nortriptyline (1) (total n = 45). In addition, Sovner et al. identified four reports of antidepressant use in children. One involved successful treatment with fluoxetine in an adolescent, another indicated efficacy with imipramine and amitriptyline in 9 of 12 children (Do-sen, 1982), and a third showed successful management in 3 of 4 children treated with imipramine or tryptophan plus nicotinamide (Dosen, 1990). One study of fluoxetine in depressed children with autism and MR witnessed improvement in depression but not in compulsive symptoms (Ghaziuddin and Tsai, 1991). 

CRH binding sites in the frontal cortex of patients with depression who have committed suicide [Nemeroff et al. 1988], the increased number of CRH-expressing neurons in the hypothalamic paraventricular nucleus of patients with depression [Raadsheer et al. 1994], and the finding that CRH concentrations in the spinal fluid decrease during long-term treatment with fluoxetine or amitriptyline [De Beilis et al. 1993] support the idea that CRH is the key neurohormone responsible for HPA alterations in depression. To clarify this point, two questions must be resolved 1] Are all HPA alterations explained by the supposed CRH hypersecretion and 2] Is CRH hypersecretion responsible for the behavioral changes seen in depression ... 

Corona CL, Cucchi ML, Santagostino G, et al Blood noradrenahne and 5-HT levels in depressed women during amitriptyline or lithium treatment. Psychopharmacology 77 236-241, 1982... 

DeKloet ER, Kovacs GL, Szabo G, et al Decreased serotonin turnover in the dorsal hippocampus of rat brain shortly after adrenalectomy selective normalization after corticosterone substitution. Brain Res 239 659-663, 1982 Del Zompo M, Bernadi F, Burrai C, et al A double-blind study of minaprine versus amitriptyline in major depression. Neuropsychobiology 24 79-83, 1991 Delespaul PhAEG Schizophrenics in Daily Life. Maastricht, Universiteitspers Maastricht, 1995... 

Glen AIM, Johnson AL, Shepherd M Continuation therapy with lithium and amitriptyline in unipolar depressive illness a randomized double-blind controlled trial. Psychol Med 14 37-50, 1984... 

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

London E, Fanelh RJ, Kimes A, et al Effects of chronic nicotine on cerebral glucose utilization in the rat. Brain Res 520 208-214, 1990 Lonnqvist J, Sihvo S, Syvalahti E, et al Moclobemide and fluoxetine in atypical depression a double-blind trial. J Affect Disord 32 169-177, 1994 Loo H, Malka R, Defance R, et al Tianeptine and amitriptyline controlled double-blind trial in depressed alcoholic patients. Neuropsychobiology 19 79-85, 1988... 

Ravaris CL, Robinson DS, Ives JO, et al Phenelzine and amitriptyline in the tteatment of depression a comparison of present and past smdies. Arch Gen Psychiatry 37 1075—1080, 1980... 

A first study with separate and combined use of IPT and antidepressants (Weissman et al. 1979) comprised 81 outpatients (12 men, 69 women) aged 18 65 years (mean approximately 30 years) suffering from moderate severe unipolar depressions and classified as neurotic depressions. Half of the patients received at least one session of 50 min of IPT per week for 16 weeks the other patients were given the name and telephone number of a psychiatrist at the clinic and could call him whenever they wanted to make an appointment. They were granted a maximum of one therapy session per month. Half of each of the two psychotherapy groups received amitriptyline in individually adjusted daily doses of between 100 and 200mg, or placebo. 

There have been five double-blind studies comparing the antidepressant efficacy of different SSRIs versus different TCAs in patients with HDRS scores of 25 or more (122, 123,124, 125 and 126). Three of these studies permitted inclusion of both inpatients and outpatients ( 122, 123 and 124), whereas the other two were solely done in outpatients (125, 126). Three were placebo-controlled (1.23, 125,126). In these three studies, the SSRI (i.e., fluvoxamine, paroxetine, or sertraline) was either superior to both the f CA and placebo or was comparable with the TCA and superior to placebo. In the other two studies, the SSRI was not different from the TCA and there was no placebo control. There have also been four studies and one metaanalysis of European clinical trials which found no difference in antidepressant efficacy between several different SSRIs and several different tertiary amine TCAs in patients hospitalized for major depression ( 127,128, 129,130 and 131). Finally, there have been two relatively small studies showing that fluoxetine and fluvoxamine both had antidepressant efficacy superior to placebo in patients with melancholia ( 132, 133). Another larger study failed to find a difference between paroxetine and amitriptyline in treating such patients ( 134). 

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 ... 

Zivkov M, Roes KCB, Pols AB. Efficacy of Org 3770 (mirtazapine) vs. amitriptyline in patients with major depressive disorder a meta-analysis. Hum Psychopharmacol 1995 10 S135-S145. 

Bremner JD, Smith WT. Org 3770 vs. amitriptyline in the continuation treatment of depression a placebo controlled trial. Eur J Psychiatry 1996 10 5-15. 

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