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Maprotiline Treatment in Depression:  A Perspective on Seizures

Eric C. Dessain, MD; Alan F. Schatzberg, MD; Bryan T. Woods, MD; Jonathan O. Cole, MD
Arch Gen Psychiatry. 1986;43(1):86-90. doi:10.1001/archpsyc.1986.01800010088011.
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• Eleven McLean Hospital (Belmont, Mass) depressed patients who experienced seizures while receiving maprotiline hydrochloride are presented, as are data on 87 cases reported to the manufacturer (Ciba-Geigy). Most seizures occurred at high dosages, sometimes after many weeks at a stable dose, but neither rapid dosage escalation nor high drug plasma levels seemed related to seizure occurrence. Our experience suggests that a long-acting metabolite might be responsible for seizures. Ten of the 11 McLean Hospital seizures occurred in patients receiving dosages outside of the since-revised current dosage guidelines, as did 60% of the seizures reported to the company. Data in this study suggest that reductions in maximum dosage of maprotiline prescribed after the initial six weeks of treatment could result in a further decrease in risk of seizures beyond that obtained from previous alterations in regimens.

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