Posted by SalArmy4me on July 11, 2001, at 2:30:52
In reply to Re: MAOI » SalArmy4me, posted by Elizabeth on July 11, 2001, at 2:02:24
> In cases of atypical depression, I disagree. It has been well established that tricyclics (at least) do not work as well as MAOIs in atypical >depression;
You're right-- MAOI's work better in atypical depression, but all the literature refers to people going from failed trials of TCA's to MAOI's and not starting a MAOI before a trial of TCA's. Maybe that shows that clinicians trust TCA's more than MAOI's as far as safety is concerned:
"A review of 10 studies reported that 62% (138/221) of patients that had failed a treatment trial of a TCA responded to a MAOI (Thase and Rush 1995). Following is a description of a selected group of reports.
Quitkin et al (1981) reported, retrospectively, that 76% of 40 patients with bipolar depression treated with a first or second-generation agent responded favorably to treatment. The authors indicated that 6 of 8 non-responders to standard antidepressants responded to a MAOI. They recommended MAOI, not another type of "cyclic" antidepressant, be used as second-line treatment when ECT is deemed unsuitable in non-responders.
Georgotas et al (1983) found that 13/20 (65%) patients responded to an average phenelzine dose of 48 mg/d (80% MAOI inhibition) in a 2 to 7 week open trial. All were TCA-resistant elderly patients and their final HRSD scores were < 10.
Pare (1985) reported that 15/26 (58%) DSM-III-diagnosed patients with depression, who had failed successive four-week trials of a first and second-generation antidepressant, respectively, responded to a trial of tranylcypromine.
Roose's et al (1986) reported all patients who failed to respond to an adequate trial of TCAs responded to MAOIs or ECT.
A double blind, placebo-controlled study reported that 17/26 (65%) TCA-failures improved with phenelzine 72 + 8 mg/d (McGrath et al 1987).
Nolen et al (1988) in an open randomized trial studied 67 patients that failed > imipramine 150 mg/d for 4 weeks. Serum concentrations were not reported. Forty-five (58%) of the patients responded to a subsequent trial of tranylcypromine.
Amsterdam and Berwish (1989) in a case series of 14 patients that failed an average of 5 different treatments reported that all patients responded to high doses of tranylcypromine. Average doses were 114 mg/d (+ 14)."
Treatment of Refractory Depression
University of Iowa Clinical Psychopharmacology Seminar
http://www.vh.org/Providers/Conferences/CPS/11.html
Original Author(s): Bruce Alexander, Pharm.D.
Latest Reviser(s): Bruce Alexander, Pharm.D., and Eric Kutscher
Creation Date: 1996
Last Revision Date: January 2000
Peer Review Status: Internally Peer Reviewed
poster:SalArmy4me
thread:69599
URL: http://www.dr-bob.org/babble/20010708/msgs/69697.html