Am J Psychiatry 1993; 150:118-123
Copyright © 1993 by American Psychiatric Association
A double-blind crossover trial of imipramine and phenelzine for outpatients with treatment-refractory depression
PJ McGrath, JW Stewart, EV Nunes, K Ocepek-Welikson, JG Rabkin, FM Quitkin and DF Klein
New York State Psychiatric Institute, NY 10032.
OBJECTIVE: Data from controlled studies concerning the response rates of
patients to a second antidepressant medication after they have been
unresponsive to a systematic trial of another antidepressant are extremely
useful to clinicians for rational prescription of pharmacotherapy. Such
information allows making an accurate prognosis, sustaining realistic hope
in the patient, and achieving the best possible therapeutic outcome. This
study was designed to add to the scanty literature available on this
subject. METHOD: Eighty-nine mood- reactive, nonmelancholic, mainly
chronically depressed outpatients at a university research clinic who were
unresponsive to vigorous double- blind trials of imipramine or phenelzine
were crossed over to treatment with the other drug under double-blind
conditions. RESULTS: Of 46 patients previously unresponsive to imipramine
who completed phenelzine treatment, 31 (67%) responded to phenelzine. Of 22
patients previously unresponsive to phenelzine who completed imipramine
treatment, nine (41%) responded to imipramine. The difference in response
rates was statistically significant. Even after they had shown no response
to 7 weeks of placebo and 6 weeks of imipramine treatment, 10 (83%) of 12
patients who then completed treatment with phenelzine responded.
CONCLUSIONS: These data suggest that among chronically ill, mood- reactive
depressed patients with many symptoms of atypical depression, phenelzine is
strikingly effective in those who have been nonresponders to imipramine and
should be tried in such patients.
