Tricyclic antidepressants staging

The REM (rapid eye movement) sleep latency decreased slightly under Hypericum treatment whereas the percentage of REM sleep remained unchanged. This is in contrast to well-known effects of tricyclic antidepressants which increase the latency while reducing the portion of REM sleep. The mean percentage of slow-wave sleep (stages 3 and 4) increased from 1.5 % to 6 % during Hypericum treatment (increase in 9 of 12 subjects), whereas it decreased from 4.1 % to 2.5 % with placebo (decrease in 7 of 12 subjects). This points to an improvement of sleep quality by Hypericum extract. 

The treatment of MDD corresponds to three stages acute phase, continuation phase, and maintenance phase. The gross treatment options should follow the strategies listed in Scheme 9.3. The following are only suggestions, which are based mainly on specific data from accumulated research. The selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are usually considered as first-line treatments. Amitriptyline and clomipramine are second-line treatments. Other tricyclic antidepressants (TCAs) and the monoamine oxidase inhibitors (MAOIs) are third-line treatments. 

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