These findings are in keeping with a good deal of emerging recent literature. The view that tricyclics are particularly effective in endogenous depression has an impressive lineage (20), going back as early as the initial open study by Kuhn (14) and the first controlled trial by Ball and Kiloh (1). However, a critical look at the controlled trials published in the 1960s suggests that, although the effect may have been a little better in endogenous depressives, there was evidence of benefit in neurotic depressives (20). Certainly there have been many controlled trials, including a number of relatively early ones in which tricyclics would have to be regarded as superior to placebo in samples characterized as neurotic or reactive (1,3,5,38,40). Part of the problem may lie in the failure to characterize further the neurotic depressives who themselves are heterogeneous, as our early cluster analytic study showed (18). More recent findings regarding delusional depression also present a problem for the earlier view. Although they are associated with psychotic/endogenous depression, there have been a number of reports indicating that delusions predict a poor response to tricyclic antidepressants (20). Depressives with delusions ap­pear to do much better with ЕСТ . It would appear that the most severe endog­enous or psychotic depressives do not respond very well to tricyclics. If anything, there is a curvilinear relationship in which the best response is shown by patients with the endogenous symptom pattern but moderate severity. Rao and Coppen (27) found the best response to amitriptyline in patients with scores in the middle range on the Newcastle Scale for endogenous depression. Other recent studies have failed to sustain with any strength the earlier views of selective response to MAO inhibitors. Ravaris et al. (28) recently found only weak differences between amitriptyline and phenelzine in symptom effects on anxious depressives. Davidson et al. (4) have analyzed the items of the Newcastle Anxiety Depression Diagnostic Index in relation to response to MAO inhibitors and tricyclics using data from several studies. The findings were mixed and inconsistent; in men, the depressed responded better than the anxious to MAO inhibitors. Liebowitz et al. (15) have, however, found some evidence that patients with reversed functional shift do better on phenelzine than imipramine. There is increasing evidence that tricyclics are superior to placebo in anxiety states and anxious depression. A tricyclic was found superior to placebo in ago­raphobics by Sheehan et al. (34) and Zitrin et al. (41) Marks (16) has reviewed a number of studies showing tricyclics superior to placebo in agoraphobics. Two important studies including a spectrum of anxious and depressed patients have not received the attention they deserve. Johnstone et al. (9) treated such patients with amitriptyline, diazepam, or placebo. Amitriptyline was consistently superior to placebo, whereas diazepam showed only weak effects, even in patients with predominant anxiety. Kahn et al. (10) carried out a similar study with imipra­mine, chlordiazepoxide, and placebo with similar findings.

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