A FOLLOW-UP STUDY ON THE CHEMOTHERAPY OF NEURODERMATITIS WITH A MONOAMINE OXIDASE INHIBITOR

Abstract

Two previous articles proposed and tested a theoretical model in which suppression of the rapid eye movement (REM) state and its daytime equivalent (basic-rest-activity cycle) would lead to significant improvement of patients with neurodermatitis. Phenelzine sulfate, 75 mg/day, was employed as the REM-suppressing agent, and diazepam, 25 mg/day, was the active control drug. A 5-week double blind study with 15 subjects yielded highly significant results. The purpose of the present study is to report: a) the clinical course of subjects who continued phenelzine therapy on a knowing basis after the 5-week experiment; b) the clinical course of the neurodermatitis once the phenelzine was discontinued; c) the types and implications of adverse reactions found with this high dosage of phenelzine. Seven of the eight subjects who continued phenelzine therapy experienced further improvement, four to the point of complete remission. The writers were also impressed by indications that some subjects seemed to need a minimal remnant of the disease, possibly because of its unconscious meanings elaborated over the years. Termination of phenelzine therapy was related to recurrence of neurodermatitis in varying ways but no subject had a return to its original extent and severity over a 4− to 8-month follow-up. Average severity of recurrence seemed to be about 25 per cent of the original pathology during this interval. Regarding adverse reactions, there were no hypertensive changes, probably due to the conscientious attitude toward diet and drugs. Two teenage subjects had severe orthostatic hypotension and phenelzine in this dosage probably should be limited to patients over 21 years of age. Mental alertness was somewhat impaired and four subjects developed hyperreflexia and tremor. Weight gain was very frequent. Subjects also developed a specific sexual dysfunction consisting of decreased libido, continued capacity to perform coitus, and anorgasmia. All adverse reactions disappeared within 1 to 3 weeks after termination of treatment. Finally, the risks in taking phenelzine sulfate, although quite variable, unpredictable, and considerable, can be partly controlled by dietary restriction and frequent medical observation. Under these circumstances, the results of this study indicate much potential value in treating moderate to severe cases of neurodermatitis, especially where alternate forms of therapy have been unsatisfactory.