Treatment strategy in depression. II. MAO inhibitors in depression resistant to cyclic antidepressants: two controlled crossover studies with tranylcypromine versus L-5-hydroxytryptophan and nomifensine.
Antidepressants are ineffective in about 30% of the patients with major depression. Besides electroconvulsive therapy (ECT) and lithium, MAO inhibitors have been suggested as an alternative in such patients. In 2 controlled, partial crossover studies involving 47 patients with major depression who had already been treated unsuccessfully with at least 2 cyclic antidepressants, the effect of the MAO inhibitor tranylcypromine was studied. The first study was an open comparison with L-5-hydroxytryptophan (L-5HTP), the second study a double-blind comparison with nomifensine. Neither the patients treated with L-5HTP nor the patients treated with nomifensine, except one, improved. In contrast, tranylcypromine was effective in 50% of the patients. The depressions of the responders to tranylcypromine appeared to be more endogenous (according Newcastle Scale II) and of shorter duration than those of the non-responders. It is concluded that MAO inhibitors such as tranylcypromine are an effective alternative to ECT and lithium in patients with major depression who have failed to respond to cyclic antidepressants.
Nolen
W A
WA
Department of Biological Psychiatry, Psychiatric Centre Bloemendaal, Hague, the Netherlands.
van de Putte
J J
JJ
Dijken
W A
WA
Kamp
J S
JS
Blansjaar
B A
BA
Kramer
H J
HJ
Haffmans
J
J
D006916:5-Hydroxytryptophan / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D016666:Fluvoxamine; D006801:Humans; D008297:Male; D008376:Maprotiline / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D009627:Nomifensine / Q000627:therapeutic use*; D010091:Oximes / Q000627:therapeutic use; D011581:Psychological Tests; D014191:Tranylcypromine / Q000627:therapeutic use*
D010091:Oximes; D009627:Nomifensine; D008376:Maprotiline; D014191:Tranylcypromine; C027299:hydroxymaprotilin; D006916:5-Hydroxytryptophan; D016666:Fluvoxamine