A double blind comparison of zimelidine and amitriptyline in endogenous depression

Abstract

In a randomised double‐blind group comparison study of 40 patients with endogenous depression zimelidine appeared to be as effective an antidepressant as amitriptyline at 4 and 6 weeks using the Hamilton Rating Scale (HRS) and the Montgomery and Åsberg Depression Rating Scale (MADRS). At 2 weeks there was a significantly better response (P < 0.05) on zimelidine compared to amitriptyline on the clinician's global scale and 4 out of 10 items on the MADRS suggesting an early onset of action. A significantly better response to zimelidine was seen on the item somatic anxiety (HRS) while the effect on sleep and appetite was better in the amitriptyline group. There were significantly more side effects, raw and corrected, in the amitriptyline‐treated group. High steady state plasma concentrations of norzimelidine (>800 nmol/l) which were significantly correlated with age (r = 0.8) were associated with a significantly poorer response suggesting that a lower dose than 200 mg in older patients may be appropriate.

Do some antidepressants promote suicide?

“…That reported for mianserin (Montgomery et al 1978) has been contradicted elsewhere (Vogel et al 1976). A report on the early selective advantage on reduction of suicidal thoughts with zimelidine which disappeared later in treatment (Montgomery et al 1981) has been mirrored by a recent similar report with another 5-HT reuptake inhibitor, fluvoxamine (Wakelin 1985). However, this is not seen in other studies.…”

Suicide: Risk factors and prevention in refractory major depression

“…In the first report of superior improvement of suicidal ideation with specific serotonin reuptake inhibitors (SSRIs). Montgomery et al (1981) studied zimelidine and amitriptyline. Their subjects had endogenous depression and had a history of responsiveness to tricyclics (TCAs).…”

Multiple approaches in neuronal activity for treating depression: More effective, more types of receptors?

“…Many psychiatrists including the authors have concluded after clinical experience that newly developed atypical antidepressants which are selective for neuronal activity are generally less potent than the traditional, tricyclic antidepressants such as imipramine or amitriptyline; however, many studies have assessed the antidepressant activities of these. new antidepressants as the full equals of or as superior to the traditional tricyclic antidepressants in double-blind trials (Montgomery et al, 1981;Standish-Barry et al, 1983;Bremner, 1984;Dominguez et al, 1985;Laursen et al, 1985;Reimherr et al, 1990). Table I shows the currently available and presumably effective antidepressants whkh show selectivity, mainly for single neurons.…”