Post-stroke depression: combined treatment with imipramine or desipramine and mianserin

Abstract

In a 6-week study the efficacy of combined treatment of imipramine plus mianserin was compared to combined treatment of desipramine plus mianserin in patients with post-stroke depression. Patients were required to have a minimum baseline total score of 15 on the 17-item Hamilton Depression Scale (HAMD). The Melancholia Scale (MES) was also used to measure severity of depressive states to show that somatic symptoms had little influence on the evaluation of depression. Out of 120 stroke patients screened, 20 patients fulfilled the inclusion criteria. The doses of the drugs were flexible, using side-effects as a guide during treatment. Both intention to treat analysis and efficacy data (excluding patients who had dropped out during the first 2 weeks of treatment) showed that imipramine (mean dose 75 mg daily) plus mianserin (mean dose 25 mg daily) was superior to desipramine (mean dose 66 mg daily) plus mianserin (27 mg daily). The MES was found to be more sensitive than the HAMD for measuring change in depressive states during treatment. The assessment of side-effects using the UKU scale showed good tolerance in general. The only difference between the two treatment groups was seen in micturition disturbances, where the imipramine treated patients had most complaints after 14 days of treatment, but the symptoms disappeared despite continuous treatment.

Cytokines, “Depression Due to A General Medical Condition,” and Antidepressant Drugs

“…Both tricyclic antidepressants (TCAs) (Schiffer & Wineman, 1990) and selective serotonin reuptake inhibitors (SSRIs) (Scott, Nussbaum, McConnell, & Brill, 1995) have been used successfully in the treatment of depression associated with multiple sclerosis, stroke (Lauritzen, Bjerg Bendsen, Vilmar, Bjerg Bendsen, Lunde, & Bech, 1994), Alzheimer's disease (Gottfries, 1997;Tueth, 1995), HIV infection (Ayuso, 1994;Rabkin, Wagner, & Rabkin, 1994), and depression induced by IFN administration (e.g., in hepatitis C or multiple sclerosis patients) (Levenson & Fallon, 1993;Mohr, Goodkin, Likosky, Gatto, Baumann, & Rudick, 1997).…”

Effects of Antidepressant Drugs on the Behavioral and Physiological Responses to Lipopolysaccharide (LPS) in Rodents

“…Chronic treatment with antidepressants, including fluoxetine, has been found to be effective in alleviating the depression associated with multiple sclerosis (Schiffer and Wineman 1990), stroke (Lauritzen et al 1994), HIV infection (Rabkin et al 1994), cancer (Razavi et al 1996), and neurodegenerative diseases (Alexopoulos 1996). Because these medical conditions are also associated with dramatic immune activation and cytokine secretion (Dinarello and Wolff 1993;Rothwell et al 1996;Yirmiya et al 1999), it may be suggested that at least part of the effects of fluoxetine (and possibly other antidepressants) in these conditions is in attenuating sickness behavior symptoms.…”

Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram.

“…These drugs have the advantage of being generally nonsedative and devoid of cardiotoxic, anticholinergic, and antihistaminergic effects. 1920 A further indication for using this approach is the recent finding that more effective treatment of PSD is obtained with the combination imipramine/mianserin than with desipramine/ mianserin, 21 with the greater efficacy of the former probably attributable to the serotonergic component of imipramine treatment. That the treatment of PSD with serotonin reuptake inhibitors is in fact effective is demonstrated by the present double-blind, placebocontrolled trial with citalopram in an unselected consecutive cohort of acute stroke patients with PSD diagnosed during the first year after stroke.…”