Controlled Trial on the Possible Advantages of a Combined Therapy with Maprotiline and Haloperidol in Endogenous Depression

Abstract

There is some clinical evidence that neuroleptics are able to increase the therapeutic effect of antidepressant drugs. From a theoretical viewpoint this could be due to influences on pharmacokinetics or receptor sensitivity. In a controlled three-week trial in 28 patients with endogenous depression the potential advantages of a combined medication of 150 mg maprotiline and 9 mg haloperidol per day (given for the first six days) in comparison with monotherapy with maprotiline were tested. Neither during the time of combined medication nor following withdrawal of haloperidol did this treatment regimen show better clinical results in comparison with controls. In keeping with results described elsewhere, the serum levels of the antidepressant, but not of its desmethyl metabolite, were higher in the experimental group.

Self-Rating Procedures in the Evaluation of Antidepressants

“…Some data from our own studies using the AMS ( fig. 3) can dem onstrate this point [39,60,76,77], In general, group-statistical results gave no evidence that rating by psychiatrists detects earlier therapeutic response or differences in therapeutic response than self-rating does or vice versa. However, also such results have been reported [58].…”

Outcome Criteria in Antidepressant Drug Trials: Self-Rating versus Observer-Rating Scales

“…In inpatients with different diagnoses, a correlation of 0.71 was found between the total scores of these scales, but this was not much higher than the correlation with the Heck Depression Inventory (0.60) (Carroll et al, 1981). maprotiline in combination with haloperidol (Möller et al, 1986), showed no difference between the two treatment procedures, either in ratings by psychiatrists or in self rating. The second study, a comparison of maprotiline oral and infusion, demonstrated a certain superiority ofthe oral medication (Fig.…”

Kombinationstherapien bei Therapieresistenz auf Antidepressiva - eine Übersicht

“…Ein Großteil der wahnhaften Depressionen, die sich auf eine Monotherapie mit Neuroleptika oder Antidepressiva nicht bessern, zeigt auf eine Kombinationstherapie dieser beiden Substanzen eine deutliche Besserung (Glassman et al, 1975;Davidson et al, 1977;Nelson u. Bowers, 1978;Minter u. Mandel, 1979;Kaskey et al, 1980;Spiker et al, 1985;Kocsis et al, 1990;Wolfersdorf et al, 1991). Abgesehen von wahnhaften Depressionen scheint die Kombination von Neuroleptika mit Antidepressiva in der Behandlung therapieresistenter Depressionen allerdings keine wesentlichen Vorteile zu zeigen (Möller et al, 1986).…”