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September 1980, Vol 37, No. 9 >
Article | September 1980

Phenelzine and Amitriptyline in the Treatment of Depression: Title and subTitle BreakA Comparison of Present and Past Studies

C. Lewis Ravaris, MD, PhD; Donald S. Robinppson, MD; John O. Ives, MD; Alexander Nies, MD; Diantha Bartlett, MS
[+] Author Affiliations

Accepted for publication Sept 26, 1979.

Read in part before the VI World Congress of Psychiatry, Honolulu, August 1977.

Reprint requests to Department of Psychiatry, East Carolina University School of Medicine, Greenville, NC 27834 (Dr Ravaris).


Arch Gen Psychiatry. 1980;37(9):1075-1080. doi:10.1001/archpsyc.1980.01780220113013
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• We present the results of a direct comparison of phenelzine sulfate and amitriptyline hydrochloride therapy in 105 depressed patients. We believe this is the first definitive double-blind controlled clinical trial of a monoamine oxidase inhibitor and a tricyclic antidepressant in the outpatient setting. The results show both antidepressants to be effective, with the similarities between the two exceeding the differences. Both drugs had marked antidepressant and antianxiety effects. Phenelzine tended to exert a stronger antianxiety action; amitriptyline was more effective in reversing weight loss and improving sleep. The incidence of two side effects, sedation and orthostatic hypotension, was almost identical. Dry mouth was more prevalent with amitriptyline. We discuss the indications for the differential clinical use of both drugs in depressed outpatients.

REFERENCES

1 +
Bosworth DM:  Discussion of the history of marsilid . J Clin Exp Psychopathol 19( (suppl 1) ):11-26, 1958;.
2 +
Davis WA:  The history of marsilid . J Clin Exp Psychopathol 19( (suppl 1) ):1-10, 1958;.
3 +
Loomer HP, Saunders JC, Kline NS:  A clinical and pharmacodynamic evaluation of iproniazid as a psychic energizer . Am Psychiatr Assoc J 8:129, 1958;.
4 +
West ED, Dally PJ:  Effects of iproniazid in depressive syndromes . Br Med J 1:1491-1494, 1959;.
5 +
Lehman HE, Cahn MD, DeVerteuil RL:  The treatment of depressive conditions with imipramine . Can Psychiatr Assoc J 3:155-164, 1958;.
6 +
Bielski RJ, Friedel RO:  Prediction of tricyclic antidepressant response—a critical review . Arch Gen Psychiatry 33:1479-1489, 1976;.
7 +
Tyrer P:  Towards rational therapy with monoamine oxidase inhibitors . Br J Psychiatry 128:354-360, 1976;.
8 +
Tyrer P:  Are monoamine oxidase inhibitors antidepressants? Proc R Soc Med 66:38-39, 1973;.
9 +
Porter AMW:  Depressive illness in a general practice: A demographic study and a controlled trial of imipramine . Br Med J 1:773-778, 1970;.
10 +
Lapolla A, Jones H:  Placebo-control evaluation of desipramine in depression . Am J Psychiatry 127:335-338, 1970;.
11 +
Raskin A, Scholterbrandt JG, Realig N, et al:  Differential response to chlorpromazine, imipramine, and placebo . Arch Gen Psychiatry 23:164-173, 1970;.
12 +
Malitz S, Kanzler M:  Are antidepressants better than placebo? Am J Psychiatry 127:1605-1611, 1971;.
13 +
Robinson DS, Nies A, Ravaris CL, et al:  The monoamine oxidase inhibitor, phenelzine, in the treatment of depressive-anxiety states . Arch Gen Psychiatry 29:407-413, 1973;.
14 +
Ravaris CL, Nies A, Robinson DS, et al:  A multiple-dose, controlled study of phenelzine in depression-anxiety states . Arch Gen Psychiatry 30:66-75, 1976;.
15 +
Kay DWK, Garside RF, Fahy TJ:  A double-blind trial of phenelzine and amitriptyline in depressed outpatients: A possible differential effect of the drugs on symptoms . Br J Psychiatry 123:63-67, 1973;.
16 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 35:773-782, 1978;.
17 +
Hamilton M:  A rating scale for depression . J Neurol Neurosurg Psychiatry 23:56-62, 1960;.
18 +
Nies A, Robinson DS, Lamborn KR, et al:  The efficacy of the MAO inhibitor, phenelzine: Dose effects and prediction of response , in Neuropsychopharmacology . Amsterdam, Excerpta Medica, 1975;, pp 765-770.
19 +
Kiloh LG, Garside RF:  The independence of neurotic depression and endogenous depression . Br J Psychiatry 109:451-463, 1963;.
20 +
Carney MWP, Roth M, Garside RF:  The diagnosis of depressive syndromes and the prediction of E.C.T. response . Br J Psychiatry 111:659-674, 1965;.
21 +
Kendell RE: The Classification of Depressive Illnesses . Maudsley Monographs No. 18, New York, Oxford University Press, 1968;.
22 +
Derogatis LR: SCL-90-R Manual , ed 1. Johns Hopkins University, 1977;.
23 +
Gehaw EA, Freireich EJ:  Non-randomized controls in cancer clinical trials . N Engl J Med 290:198-203, 1974;.
24 +
Hamilton M, White JM:  Clinical syndromes in depressive states . J Ment Sci 105:985-998, 1959;.
25 +
Hordern A: Depressive States: A Pharmacotherapeutic Study . Springfield, Ill, Charles C Thomas Publisher, 1965;.
26 +
Rosenthal SH, Klerman GL:  Content and consistency in the endogenous depressive pattern . Br J Psychiatry 112:471-484, 1966;.
27 +
Rosenthal SH, Gudeman JE:  The endogenous depressive pattern: An empirical investigation . Arch Gen Psychiatry 16:241-249, 1967;.
28 +
Klerman GL, DiMascio A, Weissman MM, et al:  Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974;.
29 +
Goldberg HL, Finnerty RJ:  Which tricyclic for depressed outpatients, imipramine pamoate or amitriptyline? Dis Nerv Syst 38:785-789, 1977;.
30 +
Sandifer MG, Wilson IC, Gambill JM:  The influence of case selection and dosage in an antidepressant drug trial . Br J Psychiatry 111:142-148, 1965;.
31 +
Davidson J, McLeod M, White H, et al: A clinical-metabolic comparison of phenelzine and imipramine. Read before the VI World Congress of Psychiatry, Honolulu, August 1977.
32 +
Sheehan DV, Ballenger J, Jacobson G:  Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms . Arch Gen Psychiatry 37:51-59, 1980;.

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1 +
Bosworth DM:  Discussion of the history of marsilid . J Clin Exp Psychopathol 19( (suppl 1) ):11-26, 1958;.
2 +
Davis WA:  The history of marsilid . J Clin Exp Psychopathol 19( (suppl 1) ):1-10, 1958;.
3 +
Loomer HP, Saunders JC, Kline NS:  A clinical and pharmacodynamic evaluation of iproniazid as a psychic energizer . Am Psychiatr Assoc J 8:129, 1958;.
4 +
West ED, Dally PJ:  Effects of iproniazid in depressive syndromes . Br Med J 1:1491-1494, 1959;.
5 +
Lehman HE, Cahn MD, DeVerteuil RL:  The treatment of depressive conditions with imipramine . Can Psychiatr Assoc J 3:155-164, 1958;.
6 +
Bielski RJ, Friedel RO:  Prediction of tricyclic antidepressant response—a critical review . Arch Gen Psychiatry 33:1479-1489, 1976;.
7 +
Tyrer P:  Towards rational therapy with monoamine oxidase inhibitors . Br J Psychiatry 128:354-360, 1976;.
8 +
Tyrer P:  Are monoamine oxidase inhibitors antidepressants? Proc R Soc Med 66:38-39, 1973;.
9 +
Porter AMW:  Depressive illness in a general practice: A demographic study and a controlled trial of imipramine . Br Med J 1:773-778, 1970;.
10 +
Lapolla A, Jones H:  Placebo-control evaluation of desipramine in depression . Am J Psychiatry 127:335-338, 1970;.
11 +
Raskin A, Scholterbrandt JG, Realig N, et al:  Differential response to chlorpromazine, imipramine, and placebo . Arch Gen Psychiatry 23:164-173, 1970;.
12 +
Malitz S, Kanzler M:  Are antidepressants better than placebo? Am J Psychiatry 127:1605-1611, 1971;.
13 +
Robinson DS, Nies A, Ravaris CL, et al:  The monoamine oxidase inhibitor, phenelzine, in the treatment of depressive-anxiety states . Arch Gen Psychiatry 29:407-413, 1973;.
14 +
Ravaris CL, Nies A, Robinson DS, et al:  A multiple-dose, controlled study of phenelzine in depression-anxiety states . Arch Gen Psychiatry 30:66-75, 1976;.
15 +
Kay DWK, Garside RF, Fahy TJ:  A double-blind trial of phenelzine and amitriptyline in depressed outpatients: A possible differential effect of the drugs on symptoms . Br J Psychiatry 123:63-67, 1973;.
16 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 35:773-782, 1978;.
17 +
Hamilton M:  A rating scale for depression . J Neurol Neurosurg Psychiatry 23:56-62, 1960;.
18 +
Nies A, Robinson DS, Lamborn KR, et al:  The efficacy of the MAO inhibitor, phenelzine: Dose effects and prediction of response , in Neuropsychopharmacology . Amsterdam, Excerpta Medica, 1975;, pp 765-770.
19 +
Kiloh LG, Garside RF:  The independence of neurotic depression and endogenous depression . Br J Psychiatry 109:451-463, 1963;.
20 +
Carney MWP, Roth M, Garside RF:  The diagnosis of depressive syndromes and the prediction of E.C.T. response . Br J Psychiatry 111:659-674, 1965;.
21 +
Kendell RE: The Classification of Depressive Illnesses . Maudsley Monographs No. 18, New York, Oxford University Press, 1968;.
22 +
Derogatis LR: SCL-90-R Manual , ed 1. Johns Hopkins University, 1977;.
23 +
Gehaw EA, Freireich EJ:  Non-randomized controls in cancer clinical trials . N Engl J Med 290:198-203, 1974;.
24 +
Hamilton M, White JM:  Clinical syndromes in depressive states . J Ment Sci 105:985-998, 1959;.
25 +
Hordern A: Depressive States: A Pharmacotherapeutic Study . Springfield, Ill, Charles C Thomas Publisher, 1965;.
26 +
Rosenthal SH, Klerman GL:  Content and consistency in the endogenous depressive pattern . Br J Psychiatry 112:471-484, 1966;.
27 +
Rosenthal SH, Gudeman JE:  The endogenous depressive pattern: An empirical investigation . Arch Gen Psychiatry 16:241-249, 1967;.
28 +
Klerman GL, DiMascio A, Weissman MM, et al:  Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974;.
29 +
Goldberg HL, Finnerty RJ:  Which tricyclic for depressed outpatients, imipramine pamoate or amitriptyline? Dis Nerv Syst 38:785-789, 1977;.
30 +
Sandifer MG, Wilson IC, Gambill JM:  The influence of case selection and dosage in an antidepressant drug trial . Br J Psychiatry 111:142-148, 1965;.
31 +
Davidson J, McLeod M, White H, et al: A clinical-metabolic comparison of phenelzine and imipramine. Read before the VI World Congress of Psychiatry, Honolulu, August 1977.
32 +
Sheehan DV, Ballenger J, Jacobson G:  Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms . Arch Gen Psychiatry 37:51-59, 1980;.

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