A controlled comparison of flupenthixol and amitriptyline in depressed outpatients.

Abstract

high-frequency stimulator that blankets the re-entry zone, and thereby fortuitously induces a suitably timed extrasystole ;3 and the variable-hysteresis orthorhythmic pacemaker.2 These are all experimental, and implantable units are not available. Fixedrate pacing, however, is known to be of value in some cases, and this may be achieved either by using a demand pacemaker with a magnetic reed switch activated by an external magnet' or by holding an external induction-coil5 or radio-frequency pacemaker6 over the site of an implanted receiver. These latter methods, however, need the active intervention of the patient. If tachycardia is associated with syncope, or if serious attacks occur during sleep, the patient may be at considerable risk before the pacemaker can be activated. Here the dual-demand pacemaker may help. By automatically switching from the demand to the fixed-rate mode in response to the rate of the heart, units can be tailored to function at rates corresponding to the patient's tachycardia. Careful intracardiac electrophysiological studies'2 will show whether the method is suitable for a particular patient. The unit can easily be tested at follow-up if competitive atrial pacing is induced by an external magnet applied over the generator, which will initiate an attack after a variable period. If the magnet is then removed the unit can be seen to function and terminate the attack.Both of our patients had pre-excitation, and such units may well have their greatest application in this field. When the bypass is left-sided, stimulation from the coronary sinus"3 offers the facility to influence both the nodal and extranodal limbs of the tachycardia circuit and may thus increase the chance of terminating re-entry. We have studied several other patients who were satisfactorily controlled by antiarrhythmic drugs in whom dual-demand pacemaking was tested successfully. For selected cases the dual-demand pacemaker offers an automatic unit that can be pretested and that works in response to the patient's own tachycardia, switching itself off after the tachycardia has been controlled unless bradycardia (perhaps due to sinoatrial disease) persists, when it acts to prevent both syncope and further recurrences.This work was supported by a grant from the British Heart Foundation. We are grateful to Dr Philippe Coumel, who helped with the investigation of case 1, for advice in the development of the pacemaker, and to Dr Celia Oakley, who kindly referred the patients. References

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

“…Future studies might test alternative treatment strategies for patients with depression complicated by persistent insomnia. Although tricyclic antidepressants (TCAs) have been largely replaced by newer drug classes because of their autonomic and cardiovascular side effects, their ability to improve not only insomnia (Haskell et al 1975;Vaisanen et al 1978;Young et al 1976), but also sleep quality (Buysse et al 1996;Feuillade et al 1992;Hajak et al 2001;Roth et al 1982;Shipley et al 1985) is well established. "Second-generation" sedating antidepressants trazodone and nefazodone (Manber et al 2003;Thase et al 2002) also improve sleep quality and provide another antidepressant monotherapy option for these patients, although their benefits need to be weighed against possible cardiovascular side effects of trazodone and the risk of hepatic failure, which resulted in the boxed warning for nefazodone.…”

Meet the relatives: a reintroduction to the clinical pharmacology of ‘typical’ antipsychotics (Part 2)

“…In a two-arm non-placebocontrolled study, Young et al (1976) found that in mild to moderate depression, flupentixol had antidepressant efficacy comparable to that of amitriptyline, with greater anti-anxiety effects.…”

Clinical trials in psychiatry

“…The principal aim of this trial was to assess the role of the convulsion in the efficacy of ECT. A second example is the comparison of flupenthixol and amitriptyline in the treatment of mild or moderately severe depression not requiring ECT in 60 out-patients (Young et al 1976); the two treatments were prescribed using flexible dose schedules for a period of 6 weeks and assessed using observer-rated and self-rated scales at initial examination and after 1, 3 and 6 weeks of treatment. The aim of the study was a controlled comparison of flupenthixol against a standard tricyclic compound in depressed out-patients.…”