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A 35-year-old woman with persistent affective and phobic symptoms responded dramatically to a combination of isocarboxazid and amitriptyline, and this improvement was maintained over the next three-and-a-half years. Isocarboxazid was replaced by placebo, using double-blind procedure. The change to placebo was accompanied by a marked increase in anxiety and depressive symptoms, which resolved when active isocarboxazid was reintroduced. It is suggested that combined antidepressant therapy still has a place in the treatment of resistant neurotic disorder. [ABSTRACT FROM AUTHOR]

Fluoxetine, a selective serotonin uptake inhibitor (mean dose 73 mg each morning) was compared with amitriptyline (mean dose 122 mg at night) in a double-blind study of 64 depressed out-patients. Fifty patients completed the 6-week trial. The drugs did not differ with respect to psychiatrists' ratings, but amitriptyline was slightly superior with respect to patients' ratings. The amitriptyline-treated group had complaints of dry mouth and dizziness on standing; the fluoxetine-treated group of sleep disturbances, nausea, and headaches. [ABSTRACT FROM AUTHOR]

It has been hypothesized that the mechanism of action of antidepressant treatments is related to their ability to decrease the sensitivity of the alpha-2 adrenergic autoreceptor. In order to assess alpha-adrenergic autoreceptor sensitivity, the effects of clonidine, the alpha-2 adrenergic receptor agonist, on plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenethyleneglycol (MHPG), blood pressure (BP) and patient-rated sedation were measured in nine depressed patients before and during amitripytline treatment. Postsynaptic alpha-2 adrenergic receptor sensitivity was assessed by determining the growth hormone (GH) response to clonidine before and during treatment. Amitriptyline significantly attenuated the effects of clonidine on plasma MHPG, standing systolic BP, and sedation, indicating that alpha-2 adrenergic autoreceptors had become subsensitive. In addition, baseline plasma MHPG levels were significantly reduced. Amitriptyline had no effect on the GH response to clonidine. [ABSTRACT FROM AUTHOR]

The effects of three single oral doses (25 mg, 50 mg and 100 mg) of amitriptyline and desipramine, and of placebo, were compared on a range of cholinergic functions (resting pupil diameter, pilocarpine-evoked miosis, baseline-sweating, carbachol-evoked sweating, salivation, heart rate) in eight healthy volunteers. Three measures (pilocarpine-evoked miosis, carbachol-evoked sweating and salivation) reflected the antimuscarinic property of the antidepressants; in two tests (pilocarpine-evoked miosis and salivation) amitriptyline appeared to be more potent than desipramine. Resting pupil diameter was not affected by amitriptyline, whereas desipramine caused mydriasis, indicating that pupil size is not a reliable measure of anticholinergic activity in the case of drugs which also affect adrenergic mechanisms. Baseline-sweating and heart rate were not affected by the antidepressants. [ABSTRACT FROM AUTHOR]

Eleven patients with obsessive thoughts were treated in two pilot studies. In the first of these patients were given thought-stopping, and this was contrasted with relaxation therapy. In the second study patients were treated by a technique described here as 'satiation', and this was followed by thought-stopping and finally a course of amitriptyline. The overall results were poor, but one type of obsessive thought responded well to satiation. [ABSTRACT FROM AUTHOR]

Two drug trials in schizoaffective patients are reported. Nineteen "schizomanic" patients were treated for one month, on a double blind basis, with chlorpromazine or lithium and 41 "schizodepressive" patients with amitriptyline, chlorpromazine or both. In the schizodepressive patients there was a trend to a better response to chlorpromazine, but drug response generally was poor, only 20 per cent of patients recovering within the month. In the schizomanic patients lithium seemed as effective as chlorpromazine, which supports the view that these patients were suffering from a variant of mania. [ABSTRACT FROM AUTHOR]

Thirty-two patients who had responded to amitriptyline (150 mg daily) when suffering from a depressive illness were allocated either to receive placebo or to remain on the same medication for one year. Plasma concentrations of the drug were regularly estimated. There was no correlation between plasma concentration and subsequent residual affective morbidity. In spite of considerable encouragement, three of the patients did not take the prescribed amitriptyline and they all relapsed. Five out of sixteen patients who received placebo relapsed. None of the patients who continued to take amitriptyline relapsed. It is emphasized that the patients studied were selected, inasmuch as they were apparent responders to amitriptyline. It is concluded that this group of patients should continue to be treated with antidepressant medication for eight months after apparent recovery, and care should be taken to ensure the patients' compliance. [ABSTRACT FROM AUTHOR]

The antidepressant activities of mianserin hydrochloride were investigated and compared with those of amitriptyline. The therapeutic efficacy of the two drugs appeared similar, but the incidence of side-effects was significantly higher with amitriptyline. Plasma levels of mianserin were determined during the trial and were not related to the therapeutic activity of the drug. [ABSTRACT FROM AUTHOR]

Hyperkinetic movement disorders may occur as side effects of antipsychotic drugs; and a hyperdopaminergic state induced by the neuroleptic compounds is thought to be a cause of extrapyramidal disorders such as tardive dyskinesia. We have observed two cases of the dyskinetic syndrome in patients receiving tricyclic antidepressants (TCA). Because the TCA are known to have little effect on striatal dopamine but do share with the neuroleptics potent anticholinergic activity, these cases appear to support the hypothesis that the drug-induced hyperkinetic disorders are related to a diminution of CNS acetylcholine activity as well as to an increase in dopamine activity. [ABSTRACT FROM AUTHOR]

The article examines the effects of brom-ergocryptine specifically on the raised prolactin levels, galactorrhoea and menstrual disturbances in patients as a result of psychotropic medication. 9 female patients at a psychiatric hospital volunteered for the investigation. The result indicated that there was no change in menstrual functioning in any of the patients. There were no discernible side effects nor significant changes in the results of routine investigations. Furthermore, there was a marked variation in mean prolactin values for individual patients.

The article presents a study on refractory cases of depressive illnesses and their response to combined antidepressant treatment. The authors' opinions differ on the effectiveness and the risk involved in treating depressive illnesses with combinations of monoamine oxidase inhibitors and tricyclic antidepressants. The patients considered for the trial were those suffering from a depressive illness, who had either failed to respond or consistently relapsed after treatment by tricyclic antidepressants. The results are presented include the determination of the nature of the depressive illness among patients who had failed to respond to antidepressants and the evaluation of the response of patients to a combination of amitriptyline and phenelzine.

The article discusses the treatment of depressed patients with combined antidepressant therapy. There are about 20 patients who were treated with depression, in which 18 were women aging 24-83 years. Patients who showed a good response to combined antidepressants have also showed a good response to electroconvulsive therapy, yet the treatment relapsed quickly. The parenteral administration of imipramine to a patient taking monoamine oxidase (MAO) inhibitors suggested that they are directly related to dosage and speed of intake. The benefits of combined antidepressants have showed that MAO inhibitors and the tricyclic antidepressants can be used together to treat patients with chronic resistant depression.

The article examines the antidepressant effect of the psychotropic drug flupentixol. The author referred to the study of patients with depressive syndrome by L. M. Sonne, which found out that the remission rate of this drug is practically the same as obtained by other previously known antidepressants. He then describes several treatments he has done in ambulatory practice and disagrees Sonne's claims about the dosage, side-effects and energizing effect of the drug. Moreover, he recommended further studies to clinics performing in-patient treatment, daily supervision, and having experience of double-blind and cross-over techniques.

The article examines the results of thirty-six depressed out-patients who were treated with either imipramine or amitriptyline at a standard dose of 50 milligrams. The doses prescribed after the first week suggest that psychiatrists attempted to keep dosage to a minimum and that they increased it only as a last resort, in either case irrespective of preference. These medications were the drugs of choice of the psychiatrists treating the patients. They tried to compare the therapeutic efficacy of the two drugs under certain conditions.

The article examines the effectiveness of amitriptyline, perphenazine and placebo in the treatment of chronically withdrawn male schizophrenics under a double-blind trial. Eighty-seven schizophrenics are randomly assigned to one of the three treatment groups. The patients are given tablets containing either a combination of 25 mg. amitriptyline and 4 mg. of perphenazine, 4 mg. perphenazine or placebo. The analysis of variance concerning the overall improvement of the individual's symptom shows that the differences between the physicians' assessments are insignificant.

The article presents a comparative trial of Limbitrol Forte or Ro 4-6270 and amitriptyline in depressive illness. They have reported the usefulness of the combination of amitriptyline and chlordiazepoxide in depressive states, but none of these was adequately controlled. It has been also reported the efficacy of a combination of an anti-depressant and a tranquillizer in improving anxiety and agitation in depressive illness, more than one would expect with an anti-depressant alone. The results of the trial show that the combination of amitriptyline and chlordiazepoxide is superior to amitriptyline in its overall anti-depressant activity, particularly in improving anxiety, agitation, irritability.

The article assesses the efficacy of amitriptyline or triptizol and amitriptyline with perphenazine or triptafen in treating depressed patients. The drugs were administered in relation to the diurnal variation of the symptoms. The discontinuation of drug intake was not carried out suddenly, however, it was reduced until it was ultimately stopped. It highlights the results of the study that enrolled a total of 71 patients who received amitriptyline and 42 patients who were given triptafen. Six patients reported a troublesome side-effects, four on amitriptyline and two on triptafen.

The article focuses on the study concerning the effect of tryptophan on the affective psychoses. The study was initiated allegedly after considering that tryptophan's metabolites may play a vital role in the aetiology and treatment of psychiatric disorders. To determine its effectiveness, 12 depressed and 6 manic patients and 6 control subjects aging from 26 to 57 years were investigated. Each was given an oral load of 1-tryptophan in wafers, and after a few hours, each urine was analyzed and examined. After urine analysis, it was concluded that there is a higher conversion of tryptophan into xanthurenic acid in manic patients and in depressed patients under drug treatment.

The article presents an analysis of the follow-up study of depression in Great Britain. There are 116 out of 137 depressed patients involved in a previous drug trial. Recurrence and re-admission rates were determined for the original amitriptyline and imipramine responders and non-responders. The efficacy of the drugs were also assessed. The results from which the study reveals indicates that the reactive and endogenous groups had similar recurrence rates and that the endogenous patients had higher re-admission rates. In addition, the findings were generally consistent with hypothesis concerning the biochemical aspect of depression and of the response to the drug treatments.

The article discusses the study on the effectiveness of antidepressant drugs such as imipramine and amitriptyline. The study was conducted at a mental hospital that covered 2,700 patients, mostly women aged 40-59 years with symptoms of severe depression. They were divided into two groups, the first group were administered with imipramine and the second, with amitriptyline. The medications were in the form of identical white capsules, imipramine of 50 milligrams and 40 milligrams of amitriptyline, in the dosage of 1 capsule given 4 times daily. The dosage was increased to 2 capsules given 3 times daily. The results revealed that some of the patients that were treated with imipramine have 90% symptom removal while those treated with amitriptyline had more than 50% of symptoms remaining.

The article presents a study on the effects on imipramine, amitriptyline, isocarboxazid and tranylcypromine in patients with depressive illness. The psychiatric consultants of St. George's Hospital were asked to refer depressed out-patients presenting depressive illness. There have been 38 patient trials on each of isocarboxazid, tranylcypromine and imipramine and 32 on amitriptyline. The side effects were observed with tranylcypromine. Twelve patients stopped the drug because of severe headache, giddiness, and hypo-plastic anemia with a sternal marrow with toxic depression.

The article presents a study on the effects of amitriptyline and imipramine in depressive psychoses. Patients were being treated with both drugs with similar doses. Neither drug was free from unwanted side-effects, although non of these were any serious consequences. Many of the patients remained on treatment with either imipramine or amitriptyline for many month, and as this may influence the incidence of side-effects the average length of treatment will be given. More patients, particularly those with uncomplicated depressions, show recovery or various degrees of improvement, the improvement sets in earlier and the maximum benefit of treatment is reached earlier.

The article seeks to examine a number of problems in the treatment of depressive states by means of a blind trial to compare the effectiveness of amitriptyline and imipramine. Taking in conjunction with the findings reported in earlier papers, the results convincingly suggest that antidepressant drugs should be used before a decision to give electroconvulsive therapy is made except in deluded depressives. It was also shown that amitriptyline is the best available antidepressant agent. Moreover, imipramine is contra-indicated in patients with cardiovascular degeneration as is amitriptyline in patients with glaucoma. Both drugs should be administered with caution in patients over 70 years old.

The article examines the effectiveness regarding the use of Amitriptyline in treating mental depression at a hospital in India. Hamilton's Rating Scale for Depression was used to provide both target symptoms agreed rating scale. Physical examination and laboratory investigation were given to each psychiatric patient. Amitriptyline has been found to have no severe side-effects other than dryness of the mouth and constipation which have been frequently complained of. Other methods and findings of the study were also discussed.

The article examines the effectiveness of Amitriptyline, an anti-depressant chemical, in treating mental depressions. It investigates the phenomenology of depressive states in women including the relationshiop between several prognostic variablesto the outcome of treatment regarding the utilization of amitriptyline and imipramine. No severe side-effects were produced by each drug but one death occurred which was probably due to imipramine. Other methods and results of the study were also discussed.

Two hundred inpatients suffering from primary depressive illness were studied. Seventy eight of the patients were treated by electroconvulsive therapy (ECT) and 122 patients received antidepressant medication. Response to ECT and antidepressant medication at 4 weeks showed a curvilinear relationship to Newcastle scores. Patients with Newcastle scores in the middle range (4-8) showed significantly higher percentage improvement than those with low (0-3) and high (9-12) scores. Ninety five patients with unipolar depression who received lithium therapy for one year were also studied. Response to lithium showed a linear relationship to Newcastle scores in these patients. It is suggested that these differences in response to antidepressant therapies reflect the heterogeneity of depressive illness. [ABSTRACT FROM AUTHOR]

The article presents a study on the trial use of new sustained release form of amitriptyline in the treatment of depressive illness. This amitriptyline is a widely used antidepressant and its effectiveness has been shown in comparison with imipramine in double blind trial. The study has noted that the new sustained release form of amitriptyline, which can be prescribed once daily in the form of a single capsule at night, appears to be a useful advance in antidepressant therapy. It has indicated that the dosage in the sustained release form shows no significant differences in effect at two-thirds of the dosage of ordinary amitriptyline.

The article discusses the study that compares nortriptyline and amitriptyline in depression. It involves 37 in-patients and 13 out-patients of a psychiatric unit, suffering from primary depressive disorders and classified into reactive and endogenous depressions. Amitriptyline is given in doses of 10 mg. for the first week, 25 mg. for the second and 50 mg. thereafter, while nortriptyline is given in doses of 10 mg. for the first week, 20 mg. for the second and 25 mg. thereafter. It is observed that treating endogenous depressions with amitriptyline is better than all other groups, while reactive depressions on this drug show the least improvement, but not inferior to both treatments using nortriptyline.

The article presents a study which evaluates the effectiveness of antidepressant drug Amitriptyline (Tryptizol) in treating depressive illness. Researchers use 70 female depressive patients who are admitted to a special unit over six months and were diagnosed with reactive or endogenous depression. These respondents were subjected to a double blind controlled trial wherein half of the patients were given amitriptyline while the other half were administered with placebo. Results suggest that amitriptyline is effective in the treatment of reactive depression and that its side-effects are not severe at therapeutically effective levels.

The article focuses the examination concerning efficacy of the antidepressant drug Amitriptyline. Researchers have claimed that Amitriptyline is still the leading antidepressant. Based on the randomized controlled trials (RCT), the drug has a small efficacy advantage over all other antidepressants, including the other tricyclics and heterocyclics. However, in current RCT in Great Britain, it showed that flouxetine had a significant advantage over amitriptyline.

A letter to the editor is presented in response to an article on seizure activity in a depressed patient caused by tricyclic antidepressants.

A letter to the editor regarding dexamethasone suppression test (DST) is presented.

A letter to the editor is presented in response to the article "The management of resistant depressives," by D. M. Shaw and R. Hewland in the 1973 issue.

The article assesses the effects of bendrofluazide, a thiazide diuretic, given to depressed patients with amitriptyline. Result of the investigation showed that combining bendrofluazide with amitriptyline did not result in any enhanced therapeutic effect in these depressed patients. However, it is not known whether there is any interaction between bendrofluazide and amitriptyline that might produce an adverse therapeutic effect. The author opines that there is still a possibility than bendrofluazide alone might exert an antidepressant effect.

A letter to the editor is presented in response to the article about the use of flupenthixol in the treatment of depressive states in the previous issue.

A letter to the editor is presented in response to the article "Combined Anti-Depressant Therapy" in the March 1971 issue.

A letter to the editor is presented about the medical case of a 64-year-old man who experienced severe depression following treatment with electroconvulsive therapy, amitriptyline and L-tryptophan for alcoholism.

The article cites a comparative trial on amitriptyline and dibenzepin drugs in the treatment of depression. The trial involves 79 patients that present symptom of acute depression. Subjects were allocated randomly to treatment groups A (amitriptyline) or D (dibenzepin). Results showed that majority of patients in both groups responded to the lower dosage level, and the onset of response and the total response was similar for both compounds. It also showed that incidence and severity of side-effects did not reflect the dosage level of the drugs used.