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Am J Psychiatry 1959;116:312-317.
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1. Preliminary observation would indicate that Tofrānil is a useful drug in the treatment of depressive states. It is not a tranquilizer and, therefore, is of little value in other conditions. It is a promising drug which can be used as an anti-depressant. However, its indication and scope must be studied for a longer period to determine what symptoms respond best to it.2. The effect of Tofrānil in many patients can be increased by the concomitant use of a tranquilizer or a stimulant. In a number of patients Tofrānil, by removing the depressive elements, frees and exaggerates anxiety.3. It can be used in combination with electric shock or after electric shock as a maintenance dose.4. It is of little value in the treatment of schizophrenics and in paranoid types may often aggravate the condition and break down an unstable equilibrium to which the patient has become adjusted.5. The combined use of Tofrānil and a tranquilizer is helpful in certain psychoneurotic states, associated with anxiety or with reactive depressions.6. It is of value in the treatment of depressions occurring in the older age group.7. High doses are unnecessary and the effective range is somewhere between 75 and 150 mgm. per day.8. For the most part, side effects are minimal, particularly in the younger age group. As one approaches the older age group, the frequency of such side effects increases, but usually they are more uncomfortable than serious. In patients over 60 there may be a tendency to sudden falls which occur without warning. It is recommended that in older patients the dosage be limited to 75 mgm. or less.9. Side effects can usually be reduced in frequency or intensity by a reduction in the dosage.10. Long-term use of the drug is apparently necessary as patients may relapse, at least in the early stages when the drug is prematurely removed. Since the drug is rapidly excreted, it is necessary to give the medication 3 times a day.

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