Amitriptyline in Depressive States: Six-month Treatment Results

Abstract

1. A number of pertinent problems in the treatment of depressive states were explored by means of a blind trial in which the effectiveness of amitriptyline was compared to that of imipramine. Sixty-nine hospitalized female depressives received the former drug and 68 similar patients the latter; 120 were followed up after leaving the hospital for six months. A matched retrospective control group of 60 patients also followed up for six months was assembled for purposes of comparison. 2. Initially 56 (81 per cent.) of 69 patients responded to amitriptyline (as judged by discharge) in contrast to 37 (54 per cent.) of 68 given imipramine (p<.002); 60 (100 per cent.) of the E.C.T. control group responded according to the same criterion. Four (9 per cent.) of the 46 patients who conscientiously took maintenance amitriptyline for six months relapsed, in contrast to four (13 per cent.) of 31 who took imipramine regularly; 16 (27 per cent.) of the E.C.T. control group relapsed within six months after discharge (significantly—p<.05—higher than the amitriptyline relapse rate). Most drug relapsers had a previous history of depressive episodes; and most responded to re-admission and increased dosage. The majority of patients relapsing after E.C.T. following drug failure had been deluded whilst in the hospital. Three patients became manic; but all had had a previous history of mania. 3. Taken in conjunction with the detailed findings reported in earlier papers, the results of the investigation convincingly suggest that: (a) except in deluded depressives, antidepressant drugs should be used before a decision to give E.C.T. is made, (b) amitriptyline is the best available antidepressant agent, (c) response to this drug can probably be predicted within a week from the failure of non-responders to improve in this time in loss of appetite, broken sleep and reduced work and interests, (d) amitriptyline—and also imipramine—should be given in maintenance for at least six months after recovery from a depressive episode, (e) imipramine is contra-indicated in elderly patients with cardiovascular degeneration as is amitriptyline in patients with glaucoma; both should be used with caution in patients over 70 years old, (f) amitriptyline given in maintenance dosage reduces the rate of relapse significantly below the rate in E.C.T.-treated depressives.