Tricyclic and Monoamine-Oxidase-Inhibitor Antidepressants: Clinical Use

Development of antidepressant drugs for the 1990s: Progress or procrastination?

“…In terms of efficacy, it is well established that in the majority of clinical studies the tricyclic antidepressants are superior to placebo treament (Morris and Beck, 1974). However, it is also accepted that only 65-70% of patients respond to tricyclic treatment (Morris and Beck, 1974;Davis, 1975;Kupfer and Detre, 1978). Davis (1975) proposed that patients showing no discernible improvement after three weeks should either have their antidepressant changed or possibly receive a course of ECT, as this treatment is suggested to be particularly efficacious in the tricyclic-resistant patient population (Kupfer and Detre, 1978).…”

“…Drug dependence is not a problem with the tricyclics, but abrupt cessation of imipramine, for example, can result in a mild withdrawal syndrome of nausea, vomiting, cramps and general malaise (Davis, 1975;Kupfer and Detre, 1978). However, these authors indicate that the symptoms can be prevented if a gradual drug withdrawal protocol is used which also helps prevent a relapse into depression.…”

“…Although the MAOIs were identified as potential antidepressants before the tricyclic reuptake inhibitors (Crane, 1957;Loomer et al, 1957), these drugs have not subsequently fulfilled the early expectations of their value in the treatment of depression. This is because while some clinical trials have demonstrated efficacy for the MAOIs in depressed patients, others have found these drugs to be of little or no benefit (Morris and Beck, 1974;Kupfer and Detre, 1978;Tyrer, 1979). Particularly noteworthy was the performance of the MAOIs in the Medical Research Council review of antidepressant treatments (Medical Research Council, 1965), where they were not only Seligiline Nialamide less efficacious than ECT or imipramine, but also less effective than placebo.…”

“…Particularly noteworthy was the performance of the MAOIs in the Medical Research Council review of antidepressant treatments (Medical Research Council, 1965), where they were not only Seligiline Nialamide less efficacious than ECT or imipramine, but also less effective than placebo. It has subsequently been suggested that the poor performance of the MAOIs may have been due to the administration of inadequate dosages (Kupfer and Detre, 1978;Paykel and Hale, 1985).…”

“…While the delay between treatment with the MAOIs and clinical improvement is generally several weeks, it is agreed that response to the first generation MAOIs, particularly tranylcypromine, can be extremely rapid (Lingl, 1964;Kupfer and Detre, 1978;Tyrer, 1979).…”