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High dose tranylcypromine for refractory depression
56A
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UlOLPSYCHIATK\ iY89;25:53A-SUA
114 HIGH DOSE TRANYLCYPROMINE DEPRESSION Jay D. Amsterdam, Neil J. Berwish Philadelphia,
FOR REFRACTORY
PA
As many as 15% of depressed patients have a refractory illness. We initiated an openlabel study using high doses of tranylcypromine (TCP) at a range of 90 mg to 180 mg daily, in fourteen refractory depressives who failed to respond to a minimum of three prior treatment regimens. Ail were outpatients with a mean t SD Hamilton depression score (HDS) of 24 -t 5. The mean age was 43 t 6 years (range 27 to 64 years), and the mean -+ SD illness duration was 18 t 12 years. The number of previous treatment failures ranged from three to 22 with a mean ? SD of 9 2 5. Response was defined as a > 50% reduction from the initial HDS and a final HDS < 10. Nine of the 14 subjects (64%) had a complete response, and three had a partial response. The mean ? SD maximum TCP dosage for the entire patient group was 128 +- 27 mg, and for the responders was 113 + 14 mg. Response was not a function of severity or duration of present episode, nor was it related to the number of prior treatment failures. The side effect profile was favorable, and most autonomic side effects occurred at moderate TCP doses and diminished at high doses. Interestingly, there was no difference in blood pressure at pretreatment and at the maximum TCP dose. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine in refractory depression.
RELATED TO PRIOR 115 ARE BIOLOGICAL ABNORMALITIES COURSE OF DEPRESSIVE ILLNESS? A. John Rush, Robin B. Jarrett, Christina M. Gullion, Monica A. Basco, John R. Debus Dallas,
‘Ix
Biological and psychological abnormalities found during a symptomatic episode of major depression may be antecedents of the episode, simple concomitants of the episode (state-dependent) abnormalities, or cumulative consequences of prior and current symptomatic periods. The latter can be established by comparing patients with distinctly different prior courses of illness. Seventy-eight outpatients with unipolar major depression (by SADS-L and RDC) were subdivided into three groups: single episode (N = 15), recurrent with complete interepisode recovery (N = 37) and recurrent with incomplete interepisode recovery (N = 26). These groups did not differ by the incidence of reduced REM latency, DST nonsuppression, RDC primary/secondary, RDC endogenouslnonendogenous, nor by Winokur’s family history subtypes. Stage 4 sleep time tended to be higher in those with single episodes. REM densities in the first three REM periods and total sleep time did not differentiate the two groups. Those with single episodes tended to be younger. Both groups with recurrent episodes had far longer total lengths of illness. These data suggest (1) reduced Stage 4 sleep time is a cumulative effect of longer illness, (2) RDC subtypes do not differ in course of illness, and (3) those recurrent episodes may have an earlier age at onset.
iwainienl Rcspunbe ~riUepresston
UlOLPSYCHIATK\ iY89;25:53A-SUA
114 HIGH DOSE TRANYLCYPROMINE DEPRESSION Jay D. Amsterdam, Neil J. Berwish Philadelphia,
FOR REFRACTORY
PA
As many as 15% of depressed patients have a refractory illness. We initiated an openlabel study using high doses of tranylcypromine (TCP) at a range of 90 mg to 180 mg daily, in fourteen refractory depressives who failed to respond to a minimum of three prior treatment regimens. Ail were outpatients with a mean t SD Hamilton depression score (HDS) of 24 -t 5. The mean age was 43 t 6 years (range 27 to 64 years), and the mean -+ SD illness duration was 18 t 12 years. The number of previous treatment failures ranged from three to 22 with a mean ? SD of 9 2 5. Response was defined as a > 50% reduction from the initial HDS and a final HDS < 10. Nine of the 14 subjects (64%) had a complete response, and three had a partial response. The mean ? SD maximum TCP dosage for the entire patient group was 128 +- 27 mg, and for the responders was 113 + 14 mg. Response was not a function of severity or duration of present episode, nor was it related to the number of prior treatment failures. The side effect profile was favorable, and most autonomic side effects occurred at moderate TCP doses and diminished at high doses. Interestingly, there was no difference in blood pressure at pretreatment and at the maximum TCP dose. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine in refractory depression.
RELATED TO PRIOR 115 ARE BIOLOGICAL ABNORMALITIES COURSE OF DEPRESSIVE ILLNESS? A. John Rush, Robin B. Jarrett, Christina M. Gullion, Monica A. Basco, John R. Debus Dallas,
‘Ix
Biological and psychological abnormalities found during a symptomatic episode of major depression may be antecedents of the episode, simple concomitants of the episode (state-dependent) abnormalities, or cumulative consequences of prior and current symptomatic periods. The latter can be established by comparing patients with distinctly different prior courses of illness. Seventy-eight outpatients with unipolar major depression (by SADS-L and RDC) were subdivided into three groups: single episode (N = 15), recurrent with complete interepisode recovery (N = 37) and recurrent with incomplete interepisode recovery (N = 26). These groups did not differ by the incidence of reduced REM latency, DST nonsuppression, RDC primary/secondary, RDC endogenouslnonendogenous, nor by Winokur’s family history subtypes. Stage 4 sleep time tended to be higher in those with single episodes. REM densities in the first three REM periods and total sleep time did not differentiate the two groups. Those with single episodes tended to be younger. Both groups with recurrent episodes had far longer total lengths of illness. These data suggest (1) reduced Stage 4 sleep time is a cumulative effect of longer illness, (2) RDC subtypes do not differ in course of illness, and (3) those recurrent episodes may have an earlier age at onset.