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Am J Psychiatry 1992; 149:195-198
Copyright © 1992 by American Psychiatric Association
Treatment of imipramine-resistant recurrent depression, IV: A double- blind crossover study of tranylcypromine for anergic bipolar depression
ME Thase, AG Mallinger, D McKnight and JM Himmelhoch
Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
OBJECTIVE: Few trials of monoamine oxidase inhibitors (MAOIs) in
tricyclic-resistant depression have had double-blind conditions. In the
authors' previous double-blind comparison of tranylcypromine and imipramine
in anergic bipolar depression, tranylcypromine was significantly more
effective. This investigation was a crossover study of nonresponders in the
initial study. METHOD: The subjects were 16 outpatients with anergic
bipolar depression. Fourteen had not responded to 4 weeks of treatment with
at least 30 mg/day of tranylcypromine or 150 mg/day of imipramine, and two
patients were crossed over because of intolerable side effects from the
initial drug. The crossover medication was prescribed as in the initial
double-blind study. RESULTS: Twelve patients were crossed over from
imipramine to tranylcypromine; nine of them responded to tranylcypromine.
Highly significant improvements were documented on the Hamilton, Beck, and
Pittsburgh Reversed Vegetative Symptom Scales. Four patients were switched
from tranylcypromine to imipramine, but only one responded. CONCLUSIONS:
The high rates of response to tranylcypromine in both the initial and
crossover double-blind studies document the efficacy of MAOI treatment for
anergic bipolar depression. Moreover, the results further illustrate the
utility of MAOIs in tricyclic-resistant depressions.
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