A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination

Berlanga, Carlos; Ortega‐Soto, Hector A.

doi:10.1016/0165-0327(95)00016-g

Cited by 31 publications

(15 citation statements)

References 6 publications

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“…We should acknowledge that pramipexole doses were increased on the basis of clinical judgment instead of a fixed-dose design, therefore limiting the capability to assess a dose-ef fect relation. The use in our cohort of multiple antidepressant associations to prevent recurrence is consistent with a previous report by Berlanga and Ortega-Soto [1995] in treatment-resistant depressed patients. With regard to tolerability, about 21.7% of patients discontinued pramipexole because of the occurrence of an adverse event.…”

Section: Discussionsupporting

confidence: 91%

Pramipexole in treatment-resistant depression: An extended follow-up

et al. 2004

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We evaluated the long-term antidepressant safety and response of adjunctive pramipexole, a D2-D3 dopamine agonist, in the course of drug-resistant depression. Twenty-three patients with treatment-resistant major depressive episode (MDE) were followed up after a 16-week pramipexole add-on trial. Pramipexole was added to current treatment with TCA or SSRI, at increasing doses from 0.375-1.500 mg/day. The LIFE scale was administered at baseline of the acute trial, at Weeks 16, 32, and 48. Patients were analyzed for sustained remission (score=<2 at LIFE for at least 8 weeks) and recurrence (after remission score > =3 at LIFE for at least 2 weeks) of depression. Of 23 patients, 12 had major depression and 11 had bipolar depression (16 women; mean age=52.8 years). Mean age of onset and median duration of current MDE were 35.1 years and 6 months, respectively; all subjects had at least two prior MDEs. Mean pramipexole dose was 0.990 mg/day. Median duration of follow-up was 28 weeks. Mean baseline MADRS and CGI-S scores were 33.7+/-8.4 (sd) and 4.6+/-0.8, respectively. Median time to sustained remission from baseline was 10 weeks and overall 60.9% (14/23) of subjects recovered within Week 22. Recurrence of depression occurred in 35.7% (5/14) of remitters after Week 24 and within Week 28 from remission. Although there were no sleep attacks, two cases of hypomania and one case of psychotic mania occurred at Weeks 22, 24, and 30, respectively. Pramipexole augmentation of antidepressant treatment was relatively safe and presumably effective in the long-term course of treatment resistant depression.

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Section: Discussionsupporting

confidence: 91%

Pramipexole in treatment-resistant depression: An extended follow-up

et al. 2004

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“…MAOIs are sometimes combined with tricyclic antidepressants (TCAs) in heroic cases, 2,10,18,58 though MAOIs are formally contraindicated in the prescribing information for patients taking antidepressants that are NE reuptake inhibitors, such as most TCAs (Table 5). This is because the sudden addition of NE reuptake blockade in someone on an MAOI may result in a hypertensive reaction.…”

Section: Mechanism Of Dangerous Drug Interactions With Maois: Decongementioning

confidence: 99%

Monoamine Oxidase Inhibitors: A Modern Guide to an Unrequited Class of Antidepressants

Stahl¹,

Felker²

2008

CNS spectr.

124

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Monoamine oxidase inhibitors (MAOIs) currently have a "bad rap" and are thus infrequently used in psychopharmacology, even by experienced clinicians. Misinformation about the dietary and drug interactions of MAOIs is widespread, whereas pragmatic tips for utilizing MAOIs to minimize risks and to maximize therapeutic actions are largely lacking in the contemporary literature. While clearly not first-line treatments, MAOIs, in the hands of experienced and well-informed clinicians, can be a powerful therapeutic intervention for patients with depression, panic disorder, and other anxiety disorders who have failed first-line treatments. This article focuses on the pharmacologic mechanisms of MAOIs, since an understanding of these mechanisms may provide a rationale to empower experts to expand their use of these agents. Discussed here are not only the mechanisms of therapeutic action of MAOIs, but also the mechanisms explaining their side effects, including hypertensive interactions with dietary tyramine (so-called "cheese reactions") and drug interactions that can lead to hypertensive reactions with some drugs and serotonin toxicities with others. This article also provides practical tips on how to use MAOIs, including debunking certain myths and giving specific guidance about which foods and drugs to avoid. Those with no previous interest in MAOIs may discover in this article a new "secret weapon" to add to their therapeutic armamentarium for patients who fail to respond to the better-known agents.

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“…To assess the long-term outcome, Berlanga and Ortega-Soto [60] treated 25 patients resistant to MAOI alone and a heterocyclic antidepressant alone with a combination of isocarboxazid and amitriptyline for a period of 3 years. Twelve of the 25 patients responded and were followed for 3 years.…”

Section: Treatmentmentioning

confidence: 99%

Treatment-Resistant Depression

Ananth

1998

Psychother Psychosom

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Our ability to treat depression has improved with the availability of receptor-specific and chemically diverse groups of antidepressants. Even now, most of the short-term studies indicate that about 20% of depressed patients remain resistant to treatment. Therefore, it is important to properly assess the treatment-resistant depressed (TRD) patients and to separate the truly refractory patients from those inadequately treated. Undiagnosed medical conditions should be eliminated. TRD is neither a clinically nor a biologically identifiable entity. As there are no established methods for the treatment of TRD, all options should be considered. The clinician can be enriched by the knowledge of the treatment modalities available, and yet, in treating an individual patient, clinical skills, intuitive judgment, family history of response to drugs and side effects, all play a vital role. Several of the approaches described in the paper indicate available methods and their merits in general but there is no way of ascertaining by which particular method a patient should be treated. The three common methods of treatment are substitution of one antidepressant drug for another, combination therapies and augmentation techniques. These are based on clinical experiences and not research findings. Therefore the treatment of TRD patients is more an art than a science. The physician should assess all the psychopathological, phenomenological and psychosocial variables to appropriately treat an individual patient.

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A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination

Cited by 31 publications

References 6 publications

Pramipexole in treatment-resistant depression: An extended follow-up

Pramipexole in treatment-resistant depression: An extended follow-up

Monoamine Oxidase Inhibitors: A Modern Guide to an Unrequited Class of Antidepressants

Treatment-Resistant Depression

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