With the advent of amphetamine-type drugs and pentamethylenetetrazol (Metrazol) (1) there has been a continued search for new antidepressants. The mono-amine oxidase inhibitors such as etryptamine (Monase) (2), phenelzine (Nardil) and nialamide (Niamide) gave fairly good results, though adverse side effects were noted in many cases. Just a few years ago another effective antidepressant was introduced-imipramine (Tofranil) (3, 4). However, side effects also were noted when this drug was given in relatively high doses to geriatric patients.Recently, various avenues of research have led to the development of a new type of antidepressant at the National Institutes of Health [Brodie's group (5)]. This new drug is desmethylimipramine (D.M.I.), which is a mono-ethyl analogue of imipramine. Desmethylimipramine is far more rapid in its action, and more potent than imipramine.Meduna, Abood and Biel (6) followed with work on anticholinergic agents. Considerable interest was aroused recently by studies of other secondary amines which led to the investigation of nortriptyline (7) (Fig. 1). This drug has a definite sedative, tranquilizing and antidepressant effect. Its discovery should open up new paths in the search for a drug of therapeutic value in the management of chronically ill and/or geriatric patients who suffer from depression, anxiety, apathy and irritability.Our investigation centered exclusively on the use of nortriptyline (Aventyl)' in the chronically ill and geriatric patient. MATERIAL AND METHODSInitially, 65 patients suffering from various chronic illnesses associated with anxiety reactions, depression and other behavioral problems were selected for this study. Their ages ranged from 34 to 87 years, with an average of 59.8 years. There were 45 males and 20 females. The diagnoses were cerebral arteriosclerosis with or without chronic brain syndrome, generalized arteriosclerosis, multiple sclerosis and other spinal cord diseases, cerebrovascular accidents due to thrombosis or embolism, various cardiac diseases, chronic alcoholism and diabetes.

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In 1946 Schlesinger (1) reported on the use of curare for the treatment of spasticity associated ·with cerebral and spinal cord diseases, and since then several articles on other skeletal-muscle relaxants for the alleviation of muscle spasm and spasticity have appeared. In 1948, Schlesinger et al. (2) published their findings on the use of mephenesin (l\1yanesin) as a centrally acting muscle relaxant. Subsequently, a number of other preparations with similar actions were found to be fairly effective (3-7). In 1963, Matthews et a!. (8) described a centrally actiw muscle relaxant known as chlorphenesin carbamate (Maolate). Clinical studies of this drug (9-14) as a muscle relaxant-analgesic or myanalgesic agent showed that good to excellent results could be obtained in a majority of patients suffering from painful musculoskeletal syndromes. This paper is a report of our experiences with chlorphenesin carbamate. PHARMACOLOGYThe chemical composition of chlorphenesin carbamate (Maolate) 1 is 3-(pchlorophenoxy) -2-hydroxypropyl carbamate.It is a well tolerated, centrally active muscle relaxant with prolonged action when administered orally. Its gross effects on behavioral and neurologic symptoms have been studied in animals and compared with those of mephenesin (Tolserol), mephenesin carbamate (Tolseram), meprobamate (Miltown, Equanil), and carisoprodol (Soma, Rela).