High-Dose Trimipramine in Acute Schizophrenia

Abstract

Trimipramine and clozapine show some similarities in receptor-binding profiles. Both have the same dissociation constant for D2-receptors and marked binding potencies for H1-receptors and muscarinic acetylcholine receptors. Based on these similarities an antipsychotic efficacy of trimipramine might be postulated. To generate hypotheses 15 schizophrenic patients with a BPRS total score of at least 50 were treated with trimipramine up to 400 mg per day. Four patients deteriorated under this treatment and had to be withdrawn from the study between the 4th and the 10th day. One patient stopped participating after the 15th day due to lack of improvement. These drop-outs showed a mean impairment in BPRS total score from 56 at baseline to 66 at endpoint. Ten patients were treated for 4 to 5 weeks successfully and improved on the BPRS from 57 at baseline to 31 at endpoint. High-dose trimipramine was tolerated well. In schizophrenic patients the expected sedative effect was small. One patient developed a modest parkinsonism, no acute dystonia was seen.

Antipsychotic Efficacy of the Antidepressant Trimipramine: A Randomized, Double-blind Comparison with the Phenothiazine Perazine

“…In an open pilot study, patients with schizophrenia (n = 28) were treated with trimipramine for 5 weeks during an acute psy-chotic episode [7,8]. Brief Psychiatric Rating Scale (BPRS) [25] total scores were significantly reduced (p < 0.05).…”

Neuroleptic Malignant Syndrome due to Atypical Neuroleptics: Three Episodes in One Patient

“…Case Report trimipramine has also been shown to have antipsychotic properties, especially in higher dosages [8]. With this medication, the patient did not experience any further psychotic symptoms for over a year.…”

Inhibitory potencies of trimipramine and its main metabolites at human monoamine and organic cation transporters

“…Interestingly, the affinity values at dopamine and 5-HT 2 -receptors and at α 1 -adrenoceptors closely resemble those observed for the atypical antipsychotic drug clozapine. This may point at the potential mechanisms of trimipramine's antipsychotic properties as large doses of trimipramine have been described to have antipsychotic effects in schizophrenic patients, without inducing extrapyramidal side effects (Eikmeier et al 1990;Eikmeier et al 1991;Seeman 1992). Recently, it has been shown to be effective in patients with delusional depression (Künzel et al 2009).…”