Efficacy and tolerability of tranylcypromine versus phenelzine: a double-blind study in antidepressant-refractory depressed inpatients.
BACKGROUND
The aim of this study was to examine whether phenelzine is a suitable alternative to tranylcypromine in antidepressant-resistant depression.


METHODS
A total of 77 severely depressed in-patients, meeting the DSM-IV criteria for major depressive disorder, who failed to respond to fixed plasma level treatment with either tricyclic antidepressants or fluvoxamine were withdrawn from psychotropic medication and included in a double-blind flexible-dose 5-week comparison of tranylcypromine and phenelzine.


RESULTS
Of the 77 patients, 67 (87%) completed the trial, of whom 35 (52%) responded. No significant differences in response between both drugs were observed. Seventeen (44%) of 39 patients responded to tranylcypromine and 18 (47%) of 38 to phenelzine (> or = 50% reduction in Hamilton Rating Scale for Depression [HAM-D] score). The mean reduction in HAM-D score was 10.4 +/- 8.3 for the tranylcypromine sample versus 8.3 +/- 8.4 for the phenelzine-treated patients. Only a few patients (10%) used concomitant psychotropic medication. A substantial number of patients experienced severe side effects, mainly dizziness, agitation, and insomnia; the incidence was the same in both samples (21%).


CONCLUSIONS
No difference in efficacy was observed between both monoamine oxidase inhibitors in a sample of patients with severe antidepressant-refractory depression. Phenelzine appears to be a suitable alternative to tranylcypromine.
Birkenhäger
Tom K
TK
Departments of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. t.birkenhager@erasmusmc.nl
van den Broek
Walter W
WW
Mulder
Paul G
PG
Bruijn
Jan A
JA
Moleman
Peter
P
D000928:Antidepressive Agents / Q000494:pharmacology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D004351:Drug Resistance; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use*; D010624:Phenelzine / Q000627:therapeutic use*; D014191:Tranylcypromine / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors; D014191:Tranylcypromine; D010624:Phenelzine