Phenelzine Imipramine

Panic disorder SSRIs Venlafaxine XR Alprazolam Clomipramine Clonazepam Imipramine Phenelzine... 

It is worth mentioning that two of the largest, most influential and independently funded early trials found little difference between the antidepressants tested and placebo. In the Medical Research Council trial comparing imipramine, phenelzine, ECT and placebo conducted in the United Kingdom (Medical Research Council 1965), it is well known that phenelzine performed poorly. However differences between... 

After ingestion of a meal that included sardines, cheese, and red wine, a patient taking an antidepressant drug experiences a hypertensive crisis. The drug most likely to be responsible is (A) Bupropion Fluoxetine Imipramine Phenelzine Trazodone... 

Amitriptyline and imipramine, and the MAOI phenelzine, can be considered second- or third-line drugs for PTSD after SSRIs have failed. Mirtaza-pine and venlafaxine may also be effective. 

Unfortunately, some patients respond poorly to these first-line interventions. In particular, patients with a long duration of illness, extreme agoraphobic avoidance, and comorbid personality disorders are more likely to exhibit a poor treatment response. For such patients, TCAs such as imipramine or clomipramine and MAOIs such as phenelzine remain viable strategies. 

Antidepressants. In the early 1980s, the recognition that depression is a frequent comorbid feature of BN coupled with the observation that appetite changes are a common feature of depression led researchers to evaluate antidepressant treatment for BN. Since that time, a series of controlled studies have demonstrated efficacy for a wide assortment of antidepressants including the TCAs imipramine (Tofranil) and desipramine (Norpramin), the MAOl phenelzine (Nardil), the SSRl fluoxetine (Prozac), and the atypical antidepressants trazodone (Desyrel) and bupropion (Wellbutrin). Overall, approximately two-thirds of antidepressant-treated patients with bulimia experience symptomatic improvement while nearly one-third achieves complete remission of binging and purging. In addition, the improvement in the symptoms of BN is not dependent on the presence of comorbid depression. 

There are four classes of antidepressants tricyclic antidepressants (imipramine, trimipramine, amitriptyline, doxepin, desipramine, protriptyline, nortriptyline, amoxapine, maprotiline) monoaminooxidase (MAO) inhibitors (phenelzine, isocarboxazid, tranylcypromine) second-generation antidepressants or atypical antidepressants, which are a chemically dissimilar group of recently proposed drugs (bupropion, trazodone, fluoxetine) and amphetamines and other stimulators of the CNS (dextroamphetamine, methylphenidate). 

Frank JB, Kosten TR, Giller EL Jr, Dan E (1988) A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry 145 1289-1291 Goddard AW, Brouette T, Almai A, Jetty P, Woods SW, Charney D (2001) Early coadministration of clonazepam with sertraline for panic disorder. Arch Gen Psychiatry 58 681-686 Goodnick PJ, Goldstein BJ (1998) SSRIs in affective disorders. I. Basic pharmacology. J Psychopharmacol 12(Suppl B) S5-S20... 

Recently, studies have addressed the use of MAOls in clinically defined populations. Liebowitz et al. [1984] studied phenelzine and imipramine in atypical depression, characterized by social rejection sensitivity similar to that seen in social phobia. Phenelzine was found to be superior to imipramine in the symptomatic relief of this interpersonal sensitivity. This finding led to subsequent studies of MAOls in populations with social phobia. 

D PP, Tam YK, Young LT, et al Dthium decreases Gs, Gi-1 and Gi-2 alpha-subunit mRNA levels in rat cortex. Eur J Pharmacol 206 165-166, 1991 Debhch I, Yirmiya R Naltrexone reverses a long term depressive effect of a toxic lithium injection on saccharin preference. Physiol Behav 39 547-550, 1987 DebowitzMR Social phobia. Mod Probl Pharmacopsychiatry 22 141-173, 1987 Debowitz MR, Quitkin EM, Stewart JW, et al Phenelzine vs. imipramine in atypical depression a preliminary report. Arch Gen Psychiatry 41 669-677, 1984 liebowitz MR, Quitkin EM, Stewart JW, et al Antidepressant specificity in atypical depression. Arch Gen Psychiatry 45 129-137, 1988 Liebowitz MR, Schneier F, Campeas R, et al Phenelzine vs atenolol in social phobia. Arch Gen Psychiatry 49 290-300, 1992... 

Liebowitz MR, Quitkin FM, Stewart JW, et al Phenelzine v imipramine in atypical depression a preliminary report. Arch Gen Psychiatry 41 669-677, 1984... 

A larger set of placebo-controlled studies show conclusively that imipramine is also effective for the treatment of panic disorders. Other agents shown to be effective in panic disorders include the SSRIs paroxetine, sertraline, fluvoxamine, fluoxetine and citalopram. Generally, initial treatment of moderate to severe panic disorders may require the initiation of a short course of benzodiazepines e.g. clonazepam (0.5 1 mg twice daily), and an SSRI. The patient will obtain immediate relief from panic attacks with the benzodiazepine whereas the SSRI may take 1 6 weeks to become effective. Once a patient is relieved of initial panic attacks, clonazepam should be tapered and discontinued over several weeks and SSRI therapy continued thereafter. There are no pharmacological treatments available for specific phobias, however controlled trials have shown efficacy for several agents, e.g. phenelzine, moclobemide. clonazepam, alprazolam, fluvoxamine. sertraline and paroxetine in the treatment of social phobia (Roy-Byrne and Cowlev, 2002). 

Pheneizine The efficacy of both reversible and irreversible MAOIs for the treatment of PTSD has been studied in controlled trials. Phenelzine has been shown to be superior to placebo and imipramine in patients with chronic PTSD who had a very low placebo response ( 271, 283). Thus, we believe phenelzine is worth trying for patients who can adhere to dietary and medicinal restrictions. 

Kosten TR, Frank JB, Dan E, et al. Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. J Nerv Ment Dis 1991 179 366-370. 

Frank JB, Kosten TR, Giller EL Jr. A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry 1988 145 1289-1291. 

Rothschild R, Quitkin HM, Quitkin FM, et al. A double blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives. Int J Eat Disora 1994 9 1-9. 

OFFICIAL NAMES Amitriptyline (Elavil), amoxapine (Asendin), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), fluoxetine (Prozac), imipramine (Norfranil, Tofranil), isocarboxazid (Marplan), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil), phenelzine (Nardil), protriptyline (Vivactil), sertraline (Zoloft), thioridazine (Mellaril), tranylcypromine (Parnate), trazodone (Desyrel), trimipramine (Sur-montil), venlafaxine (Effexor) the herb St. John s wort (Hypericum perforatum) is sold over-the-counter without prescription STREET NAMES Happy pills... 

A carefully controlled 3-week comparison of phenelzine (up to 90 mg/day, mean 77 mg) and imipramine (up to 150 mg/day, mean 139 mg) showed no significant difference between the drugs in the incidence of dry mouth, blurred vision, constipation, and urinary hesitancy (15). 

Phenelzine, imipramine, and placebo in borderline patients meeting criteria for atypical depression. Psychopharmacol Bull 1989 25 524-34. 

Insomnia and daytime somnolence and fatigue have been reported with tranylcypromine, phenelzine, and isocarboxazid (SEDA-16, 8) (SEDA-17, 16). In a comparison of phenelzine and imipramine (15) there were important and significant differences between the drugs 19% of the patients taking phenelzine reported drowsiness compared with none of those taking imipramine moreover, 18 patients taking phenelzine had to be withdrawn, compared with one taking imipramine (who developed urinary retention). Central nervous system toxicity was also reported after an abrupt switch from phenelzine to isocarboxazid (SEDA-17, 17). 

Clinically important, potentially hazardous interactions with albuterol, alpha-blockers, amitriptyline, amoxapine, atenolol, beta-blockers, carteolol, chlorpromazine, clomipramine, cocaine, desipramine, doxepin, ephedra, ergotamine, furazolidone, halothane, imipramine, insulin detemir, MAO inhibitors, metoprolol, nadolol, nortriptyline, oxprenolol, penbutolol, phenelzine, phenoxybenzamine, phenylephrine, pindolol, prazosin, propranolol, protriptyline, sympathomimetics, terbutaline, thioridazine, timolol, tranylcypromine, tricyclic antidepressants, trimipramine, vasopressors... 

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