Imipramine major depression

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

Rein W. Amisulpride versus imipramine and placebo in dysthymia and major depression. Amisulpride Study Group. J Affective Disord 1997 43(2) 95-103. 

Schweizer E, Rickels K, Hassman H, Garcia-Espana F. (1998). Buspirone and imipramine for the treatment of major depression in the elderly. J din Psychiatry. 59(4) 175-83. 

A breakthrough in the treatment of major depression was the discovery of fluoxetine, marketed as Prozac. Fluoxetine has a mechanism of action similar to that of imipramine with an important exception. It is a selective serotonin reuptake inhibitor, an SSRI. This strongly suggests that, in some sense, the symptoms of major depression result from a deficit in serotonin specifically. By inhibiting its reuptake from the synapse, the activity of serotonin is enhanced. Two other important drugs for major depression, sertraline (Zoloft) and paroxetine (Paxil), among several others,... 

Lenox RH, Shipley JE, Peyser JM, Williams JM, Weaver LA (1984) Double-blind comparison of alprazolam versus imipramine in the inpatient treatment of major depressive illness. Psychopharmacol Bull 20 79-82... 

Seven TCA drugs are available in the United States for treatment of major depression. They are generally categorized as tertiary or secondary amines. Tertiary amines include imipramine (Tofranil), amitriptyline (Elavil), trimipramine (Surmontil), and doxepin (5m-equan). Desipramine (Norpramin), nortriptyline (Pam-elor), and protriptyline (Vivactil) are secondary amines. 

Puig-Antich, J., Perel, J.M., Lupatkin, W, Davies, M., and Goetz, D. (1987) Imipramine in prepubertal major depressive disorders. Arch Gen Psychiatry 44 81-89. 

Precursor therapy as a means of increasing dopaminergic transmissions is limited to L-tyrosine and L-dopa. Although under basal conditions the exogenous administration of tyrosine leads to specific enhancement of noradrenergic transmission, it can enhance dopaminergic transmission in conditions of DA deficiency [Kapur and Mann 1992). Only one adequately controlled clinical trial has been reported, in which 65 patients with major depression were randomly selected to treatment for 4 weeks with oral L-tyrosine 100 mg/kg/day, imipramine 2.5 mg/kg/day, or placebo [Gelenberg et al. 1990). Tyrosine increased and imipramine decreased excretion of the main metabolite of NA, but no evidence was found that tyrosine had antidepressant activity in contrast with imipramine. 

Comparisons of imipramine versus placebo for prevention of recurrences of major depressive disorder ... 

Bakish D, Hooper CL, Filteau MJ, et al A double-blind placebo-controlled trial comparing fluvoxamine and imipramine in the treatment of panic disorder with or without agoraphobia. Psychopharmacol Bull 32 135-141, 1996 Bakish D, Hooper CL, Thorton MD, et al Fast onset an open study of the treatment of major depressive disorder with nefazodone and pindolol combination therapy. Int Clin Psychopharmacol 12 91-97, 1997 Baldwin DS Depression and sexual function. J Psychopharmacol 10 (suppl l) 30-34, 1996... 

Eysselein V, Eberlein G, Ho FJ, et al An amino-terminal fragment of cholecystokinin-58 is present in the gut evidence for a similar processing site of procholecystokinin in canine gut and brain. Reg Peptides 22 205-215, 1988 Fabre L, Vettraine J, Birkhimmer L, et al Fluvoxamine in the treatment of depression a double-blind comparison with imipramine and placebo in outpatients with major depression. Paper presented at the 18th CINP Congress, Nice, France, 1992... 

Feighner JP, Boyer WF, Meredith CF, et al A double-bhnd comparison of fluoxetine, imipramine and placebo in outpatients with major depression. Int Clin Psychopharmacol 4 127-134, 1989b... 

Fontaine R, Ontiveros A, Ehe R, et al A double-blind comparison of nefazadone, imipramine and placebo in major depression. J Clin Psychiatry 55 234-241, 1994 Fontana DJ, Daniels SE, Flenderson C, et al Ondansetron improves cognitive performance in the Morris water maze spatial navigation task. Psychopharmacology 120 409-417, 1995... 

Jakovljevic M, Mewett S Comparison between paroxetine, imipramine and placebo in preventing recurrent major depressive episodes. Eur Neuropsychopharmacol 1 440, 1991... 

Kim SW, Dysken MW, Pandey GN, et al Platelet 3H-imipramine binding sites in OC behavior. Biol Psychiatry 30 467-474, 1991 Kindler S, Shapira B, Hadjez J, et al Factors influencing response to bilateral electroconvulsive therapy in major depression. Convulsive Therapy 7 245-254, 1991... 

March JS, Kobak KS, Jefferson JW, et al A double-blind placebo-controlled trial of fluvoxamine versus imipramine in outpatients with major depression. J Clin Psychiatry 51 1027-1033, 1990... 

Rickels K, Schweizer E, Clary C, et al Nefazodone and imipramine in major depression a placebo-controlled trial. Br J Psychiatry 164 802-805, 1994 Riddell EG Studies on Li" transport using 7Li and 61i nuclear magnetic resonance, in Lithium and the Cell. Edited by Birch NJ. San Diego, CA, Academic Press, 1991, pp 85-98... 

Most efficacy trials with reboxetine have so far only been published in review articles ( 178). Most of these articles did not have peer review and do not contain the full details concerning methodology or results. This fact limits the ability to accurately determine its relative efficacy and tolerability. In short-term (4 to 8 weeks), placebo-controlled clinical trials, reboxetine produced a response (defined as at least a 50% reduction in severity scores) in 56% to 74% of patients. These results were statistically superior to placebo in most studies. Reboxetine was also found to be as effective as imipramine and desipramine in four double-blind, randomized, active-controlled (but not placebo-controlled) studies involving more than 800 outpatients or inpatients with major depression. Reboxetine produced equivalent antidepressant response rates compared with fluoxetine in two clinical trials, one of which was also placebo-controlled. However, reboxetine was reported to have improved social motivation and behavior more than fluoxetine as assessed by the newly developed Social Adaptation Self-Evaluation Scale. In all of the studies, reboxetine had a similar time (i.e., 2 to 3 weeks) to onset of the antidepressant efficacy as do other antidepressants. 

Feighner JP, Boyer WF, Meredith CH, et al. A placebo-controlled inpatient comparison of fluvoxamine maleate and imipramine in major depression. Int Clin Psychophannacol 1989 4 239-244. 

Rickels K, Schweizer E, Clary C, et al. Nefazodone and imipramine in major depression a placebo-controlled trial. Br J Psychiatry 1994 164 802-805. 

Berzewski H, Van-Moffaert M, Gagiano CA. Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive episodes. Eur Neuropsychopharmacoi 1997 7 S37-S47... 

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