Neurotic depressions, treatment

Etryptamine (88) and MP-809 (10) are particularly effective in the treatment of neurotic depressions. Etryptamine has since been removed from the market because of a few instances of blood dyscrasias which were thought to be related to the drug (102). Compound MP-809 produced a significant antidepressant action in 74% of neurotic depressions and in 52% of all types of mental depression (10). While etryptamine exhibits definite MAO inhibitory effects in the laboratory, its action in man is rather weak in this respect (68, 88, 99). Furthermore, MP-809, which displayed rather potent antidepressant effects in man, is only a weak MAO inhibitor in the laboratory (10). Hence, the mode of action of this group of drugs does not appear to be a consequence of either MAO inhibition or psychomotor stimulation. 

The effect of this structural hybrid formation was an antidepressant drug with tranquilizing and antianxiety properties (59). The drug was most effective in neurotic depressions and of little value in psychotic depressive reactions (59, 85). Its activity range would thus appear to be between imi-pramine and meprobamate (85). Side effects were minimal with this drug and its onset of action occurred within 1 to 2 days (81). Hence, the drug is particularly useful in the treatment of ambulatory patients. 

Schmidt and Sommer 1993 65 (15 m/50f) neurotic depression or brief depressive reaction (HAMD 15-20) [ICD-9 300.4, 309.0] Jarsin (LI 160) 3 x 300 mg 6 weeks A all randomized patients (Hyp 32, Pic 33) R HAMD response rate (decrease in total score >50% or total score <10) 66.6% (placebo 26.7%) Cognitive performance tests (Vienna determination device and Test d2 acc. to Brickenkamp no impairment of attention and choice reaction time due to Hypericum treatment... 

Whereas antipsychotics and antidepressants are used mainly in major psychiatry , Le. in the treatment of schizophrenia and depression, anxiolytics are also used in general medicine for the treatment of neurotic, vegetative, psychosomatic and even purely physical conditions. This multiple usage is promoted by the fact that anxiolytics of the benzodiazepine type have an almost exclusively central action so that vegetative effects (dry mouth, sweating, visual disturbances, urine retention, constipation, fall in blood pressure), which can be unpleasant for patients or even hazardous, are practically absent. 

Both conclusions apply to outpatients with neurotic (i.e. rather lighter and generally non-endogenous) forms of depression. Two of the three investigations dealt with maintenance therapy of patients who had already shown pronounced symptomatic improvement with antidepressant treatment. 

Treatment with psychedelics has most often been described as ineffective in cases of hysterical neurosis and hysteria, stuttering neurosis, infantile personality, and long-term neurotic invalidism. Despite reported successes, compulsive syndromes, criminal psychopathy, and depressive states are also mentioned as contraindicated. The risks frequently have been considered too great for paranoids, severely depressed persons, outpatient psychotics and pre-psychotics, and those with a history of suicide attempts or who may be currently suicidal. However, as we have previously suggested (Masters and Houston, 1966), psychedelic therapy may be indicated in cases where suicide seems probable and imminent. By his being enabled to die symbolically and then be reborn, the patient s need to die may be subsequently eliminated. 

Two of these studies reported that the antidepressant was superior for patients with "retarded" depression, whereas the neuroleptic was superior for anxious or neurotic patients (Hollister et al. 1967 Raskin et al. 1970). This is readily understandable, given what we know of the drug-induced effects of neuroleptics. Their deactivation effects are likely to compound psychomotor retardation and reduce agitation and anxiety. Reserpine, the drug that was believed to induce a depressive state, was found to be clearly superior to placebo for the treatment of depression in an early trial conducted at the Maudsley hospital in London (Davies Shepherd 1955). 

During the first half of the 1900s, amphetamines were used in the treatment of depression and narcolepsy, and carbon dioxide in the treatment of various psychotic and neurotic conditions. 

Amitriptyline resembled imipramine in its efficacy in the treatment of endogenous depression and its relative ineffectiveness in patients with neurotic (reactive) depressive symptoms (9). Some patients, who were unreactive to imipramine, responded to amitriptyline (9). Side effects were usually less severe (9, 34, 114) but there was a high incidence (18%) of somnolence (114). Some of the disadvantages inherent in imipramine were overcome, at least to some extent, by this structural variant ... 

Phenelzine, a monoamine oxidase (MAO) A inhibitor (15 mg t.i.d.), is indicated in treatment of depressed patients clinically characterized as atypical, nonendogenous, or neurotic. These patients often have mixed anxiety and depression and phobic or hypochondriacal features (see also Tables 5 through 7). 

Tianeptine sodium is a structurally novel, serotonin specific antidepressant. It is useful in the treatment of neurotic and reactive depressions, as well as depressive states accompanied by anxiety. 

Thiothixene, useful in treatment of schizophrenia, was also found useful in treating neurotic patients In another study, it was found as effective as the perphenazine-amitriptyline combination in treating psychoneurotic depressive symptoms4 ... 

Mother s mental health was assessed by a questionnaire on neurotic and depressive symptoms, and by interview questions on depression, suicidal thoughts, psychiatric treatment, anxiety, and personality disorders. High scores are indicative of mental ill-health. 

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