title: Efficacy of imipramine in psychotic versus nonpsychotic depression.
abstract: The purpose of the present study is to compare the efficacy of imipramine in the treatment of psychotic versus nonpsychotic depression. Previous studies report varying results of monotherapy with antidepressants in psychotic depression. Because psychotic depression is seriously underinvestigated, performing a post hoc analysis of randomized clinical trials consisting of both psychotic and nonpsychotic depressed patients may contribute to the discussion on the optimal treatment of depressed patients with mood-congruent psychotic features. A total of 112 patients diagnosed with major depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (40 with psychotic depression and 82 without psychotic features) received treatment with imipramine for 6 weeks after a washout period of 7 days. Imipramine doses were adjusted to attain a predefined fixed plasma level. Treatment response was assessed with the Hamilton Rating Scale for Depression (HAM-D). A logistic regression analysis showed a significantly larger reduction in HAM-D score in the sample with psychotic features compared with the nonpsychotic sample (regression coefficient, -3.47; SE, 1.7; P = 0.04). According to the primary outcome criterion, that is, the change in HAM-D score, imipramine was significantly more effective in the sample with psychotic depression compared with the nonpsychotic depressed patients. The contradiction between our results and those of several previous studies may be due to the fixed plasma level dosing of imipramine refraining from concurrent psychotropic medication or limiting our patient sample to patients with mood-congruent psychotic features.
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. t.birkenhager@erasmusmc.nl
authors.forename: Tom K
authors.initials: TK
authors.lastname: Birkenhager
authors.forename: Walter W
authors.initials: WW
authors.lastname: van den Broek
authors.forename: Paul G
authors.initials: PG
authors.lastname: Mulder
authors.forename: Peter
authors.initials: P
authors.lastname: Moleman
authors.forename: Jan A
authors.initials: JA
authors.lastname: Bruijn
mesh_terms: D000328:Adult; D000341:Affective Disorders, Psychotic / Q000188:drug therapy* / Q000523:psychology; D000368:Aged; D000928:Antidepressive Agents / Q000378:metabolism / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D003891:Desipramine / Q000097:blood / Q000378:metabolism; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D007099:Imipramine / Q000378:metabolism / Q000627:therapeutic use*; D016015:Logistic Models; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D006220:Haloperidol; D008140:Lorazepam; D007099:Imipramine; D003891:Desipramine