WHICH TREATMENT FOR DEPRESSION?

Mianserin may relieve depression better than amitriptyline Few studies have compared the tettacyclic antidepressant mianserin with the tricyclic amitriptyline. In a double-blind 4-week trial, 47 depressed patients received 30mg ofmianserin ('Norval'; Bencard), 60mg ofmianserin, or 50mg of sustained release amitriptyline ('Lentizol; Warner), each as a single nightly dose. All 3 regimens produced progressive improvement on Hamilton Rating Scale scores for depression, starting in the first week. Although the efficacy of the regimens did not differ significantly, mianserin 60mg tended to be most effective in both objective and subjective assessments, and mianserin 30mg was least effective. However, 8 of the 19 patients on mianserin 60mg, as compared with 2 of the 15 on amitriptyline had to drop out of the trial after 2 weeks owing to nausea, vomiting, diarrhea or other reasons. Otherwise, mianserin was associated with 4 largely tolerable side effects (unsteady walk, blurred vision, dizziness and metallic taste) and amitriptyline with 3 (blurred vision, metallic taste and constipation). Mehta, B.M. et aI.: Current Medical Research and Opinion 7: 14 (No I. 1980)

Amitriptyline and tranylcypromine used together with concurrent graduated dosage increase In a randomized trial, 30 patients with major or minor depressive disorders were assigned to amitriptyline alone (up to 300mg daily), tranylcypromine alone (up to 40mg daily), or a combination of amitriptyline (up to 150mg daily) and tranylcypromine (up to 20mg daily). 28 patients completed treatment for 4 weeks or until discharge. Patients in each treatment group responded equally well according to Hamilton and Zung depression scale ratings. Although the combination was associated with a higher incidence of headache, paresthesias, urinary frequency, muscle spasms, and insomnia, these did not result in stopping therapy. No patient on the combination became hypertensive or hyperthermic.

'The area of combination MAOI-tricyclic antidepressant treatment requires more controlled clinical studies to determine the true indications for this approach.'

While. K. et a!. : American Journal of Psychiatry 137: 1422 (Nov 1980)

10 INPHARMA 20 Dec 1980 0156-2703/80/1220-0010 $00.50/0 ©AOIS Press