Depression maprotiline

Maprotiline, Moclobemide, Mianserin, Fluoxetine (Prozac), Paroxetine, Sertraline, Fluvoxamine, Citalopram, Venlafaxin (generic IR formulation and the brand Venlafaxine XR), Mirtazapine, Flupentixol-melitracen (Deanxit), Tianeptine, Extract of St. John s Wort, Buspirone Depression and anxiety... 

The excellent clinical efficacy of the TCAs has been well documented and the pharmacokinetic profiles are favourable. The most serious disadvantage of the TCAs lies in their cardiotoxicity. Thus, with the exception of lofepramine, all the tricyclic antidepressants, including maprotiline, block the fast sodium channels in the heart which can lead to heart block and death. Approximately 15% of all patients with major depression die by suicide and a high proportion of these (up to 25%) do so by taking an overdose of TCAs. Such a dose can be as low as 5-10 times the recommended daily dose. 

It disrupts neuronal reuptake of monoamines in the CNS and possesses moderate tranquilizing and cholinergic activity. It improves mood significantly and relieves feelings of fear. Maprotiline is used in various forms of depression accompanied by a feeling of fear and irritability. Ludiomil is a synonym of maprotiline. 

MAPROTILINE HYDROCHLORIDE For the treatment of depressive illness in patients with depressive neurosis (dysthymic disorder) and manic-depressive illness, depressed type (major depressive disorder) also effective for the relief of anxiety associated with depression. 

Mild to moderate depression An initial dose of 75 mg/day is suggested for outpatients. In some patients, especially the elderly, an initial dose of 25 mg/day may be used. Because of the long half-life of maprotiline, maintain initial dosage for 2 weeks. Gradually increase the dosage in 25 mg increments, as required and tolerated. Most patients respond to a dose of 150 mg/day, but doses as high as 225 mg/day may be required. 

Monitoring Discontinue maprotiline if there is evidence of pathological neutrophil depression. Perform leukocyte and differential counts in patients who develop fever and sore throat during therapy. 

Geriatric Considerations-Summary Given the side-effect profile, and potential drug interactions, maprotiline is not recommended for treatement of depression in older adults. 

Most child and adolescent studies published thus far have focused on the effects of the tricyclic antidepressants (TCAs) and, more recently, the SSRIs. A few open studies have also shown that monoamine oxidase inhibitors (MAOIs) can be used safely with children and adolescents (Ryan et ah, 1988b), but noncompliance with dietary requirements may present a significant problem for minors. Other antidepressants, including the heterocyclics (HTC) (e.g., amoxapine, maprotiline), buproprion, venlafaxine, and nefazodone, have been found to be efficacious for the treatment of depressed adults (APA, 2000), but they have not been well studied for the treatment of MDD in children and adolescents. Therefore, this chapter mainly describes the use of SSRIs and TCAs for youth with MDD. 

Borsini F, Meli A Is the forced swimming test a suitable model for revealing antidepressant activity Psychopharmacology 94 147-160, 1988 Borsini F, Lecci A, Mancinelli A, et al Stimulation of dopamine D2 but not Dj receptors reduces immobility time of rats in the forced swimming test implication for antidepressant activity. Eur J Pharmacol 148 301-307, 1988 Bouchard JM, Delaunay J, Delisle J-P, et al Citalopram versus maprotiline a controlled clinical multicenter trial in depressed patients. Acta Psychiatr Scand 76 583-592, 1987... 

Rouillon F, Serrurier D, Miller H, et al Prophylactic efficacy of maprotiline on unipolar depression relapse. J Chn Psychiatry 52 423-431, 1991 Rowan MJ, Cullen WK, Moulton B Buspirone impairment of performance of passive avoidance and spatial learning tasks in the rat. Psychopharmacology 100 393-398,... 

Results of crossover studies indicate that lithium is efficacious in treating acute depression in bipolar subjects unequivocally (36%, 29/80) and partially (43%. 34/80). respectively (Xomberg and Pope, 1993 Keck and McElroy, 2002). Various antidepressants have shown variable rates of efficacy in the treatment of acute bipolar depression, i.e. desipramine (50%), maprotiline (67%), imipra-mine (40 60%), tranylcypromine (87%), moclobemide (53%) and fluoxetine (60%) (Keck and McElroy, 2002). Among the anticonvulsants, valproic add and lamotrigine appear to have some potential efficacy in the treatment of acute bipolar depression (Calabrese et al., 1992, 1999 Fatemi et al., 1997). 

Depressed patients with an eating disorder (i.e., anorexia or bulimia) or a history of seizures should not take bupropion or maprotiline because of an increased risk of seizures. 

VanDer Velde C. Maprotiline versus imipramine and placebo in neurotic depression. J din Psychiatry 1981 42 138-141. 

Rouillon F, Phillips R, Serrurier D, et al. Rechutes de depression unipolaire et efficacite de la maprotiline. L Encephaie 1989 15 527-534. 

McCallum P, Meares R. A controlled trial of maprotiline (Ludiomil) in depressed outpatients. MedJAust 1975 2 392-394. 

Kasper S, Dotsch M, Vieira A, et al. Plasma concentration of fluvoxamine and maprotiline in major depression implications on therapeutic efficacy and side effects. Eur Neuropsychopharmacol... 

Lamictal (lamotrigine) for epilepsy, Lamisil (terbinafine) for nail infections, Ludiomil (maprotiline) for depression, and Lomotil (diphenoxylate) for diarrhea... 

Realini R, Mascetti R, Calanchini C. Efficacite et tolerance du moclobemide (Ro 11-1163 Aurorix) en comparaison avec la maprotiline chez des patients ambulatoires presen-tant un episode depressif majeur. [Effectiveness and tolerance of moclobemide (Ro 11-1163 Aurorix) in comparison with maprotiline in ambulatory patients presenting with a major depressive episode.] Psychol Med 1989 21 1689. 

Speech blockage, so called, has been reported in a 34-year-old woman who had taken phenelzine 45 mg/day for 2 months (3). The adverse effect disappeared on withdrawal and did not recur when her depression was successfully treated with maprotiline 175 mg/day. 

Myoclonus due to maprotiline has been reported (13). Further neuromuscular symptoms that have been reported with maprotiline include cerebellar ataxia in a 54-year-old man with a history of unipolar depression and chronic alcohol abuse who was taking maprotiline 200 mg/day (14). The question of whether his history of alcohol abuse contributed by sensitizing his cerebellum to maprotiline-induced ataxia was unresolved. 

Forrest WA. Maprotiline (Ludiomil) in depression a report of a monitored release study in general practice. J Int Med Res 1977 5(Suppl 4) 112-5. 

Vaisanen E, Naarala M, Kontiainen H, Merilainen V, Heikkila L, Malinen L. Maprotiline and doxepin in the treatment of depression. A double-blind multicentre comparison. Acta Psychiatr Scand 1978 57(3) 193-201. 

Claghorn JL. A double-blind study of maprotiline (Ludiomil) and imipramine in depressed outpatients. Curr Ther Res Clin Exp 1977 22 446. 

Dessain EC, Schatzberg AF, Woods BT, Cole JO. Maprotiline treatment in depression. A perspective on seizures. Arch General Psychiatry 1986 43(l) 86-90. 

A 72-year-old woman taking venlafaxine 150 mg/day for depression was abruptly switched to the noradrenaline re-uptake inhibitor maprotiline 75 mg/day 1 day later she developed agitation, sweating, nausea, vomiting, tinnitus, and insomnia (27). These symptoms continued for another week, but disappeared on the second day of sertraline treatment 50 mg/day. 

Increased depressive effects when taken with other CNS depressants Cimetidine raises loflazepate plasma levels Rapid dose reduction or discontinuation of loflazepate during concomitant use with tetracyclic antidepressants such as maprotiline may result in convulsive seizures, possibly due to the loss of anticonvulsant actions that suppress the pro-convulsant actions of tetracyclic antidepressants... 

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