The clinical relevance of treatment with antidepressants

1995 ◽  
Vol 7 (2) ◽  
pp. 52-54 ◽  
Author(s):  
W.A. Nolen
Keyword(s):  
Monoamine Oxidase ◽  
Clinical Relevance ◽  
Rating Scales ◽  
Monoamine Oxidase Inhibitor ◽  
Oxidase Inhibitor ◽  
Tricyclic Antidepressant ◽  
Statistical Evidence ◽  
Monoamine Oxidase A ◽  
Selective Serotonin ◽  
Uptake Inhibitors

Oince the discovery in the late 1950's of imipramine (Tofranil®), the first tricyclic antidepressant (TCA), and iproniazid, the first monoamine oxidase inhibitor (MAOI), many other TCAs and MAOIs, now being considered the classical antidepressants, have become available. Their effectiveness has been shown in numerous studies, although according to nowadays standards well designed studies (placebo-controlled, defined diagnostic groups, the use of standardized rating scales) with these compounds are relatively scarce.From the early 1980's the so called modern antidepressants have been introduced: the selective serotonin re-uptake inhibitors (SSRIs), the reversible selective monoamine oxidase-A inhibitors (RIMAs) and a variety of other compounds. All these drugs have been registered after their effectiveness had been shown in well designed, placebo-controlled studies. In defining the efficacy of antidepressants, registration authorities consider two aspects important: statistical evidence and clinical relevance.

scholarly journals Development of new antidepressants

1997 ◽  
Vol 3 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Eleni Palazidou
Keyword(s):  
Monoamine Oxidase ◽  
Turning Point ◽  
Monoamine Oxidase Inhibitor ◽  
Depressive Illness ◽  
Oxidase Inhibitor ◽  
Tricyclic Antidepressant ◽  
Antituberculous Drugs ◽  
One Year

The development of the first effective antidepressants in the late 1950s marked a turning point in the treatment of depressive illness. In 1957 the monoamine oxidase inhibitor (MAOI) iproniazid was discovered by chance, while searching for new antituberculous drugs. One year later the tricyclic antidepressant (TCA) imipramine was introduced, having been developed originally as an antipsychotic. A number of other drugs were subsequently added to these two groups of antidepressants, which dominated the field for the next three decades.

Tyramine and New Monoamine Oxidase Inhibitor Drugs

1989 ◽  
Vol 155 (S6) ◽  
pp. 32-37 ◽  
Author(s):  
G.M. Simpson ◽  
J. de Leon
Keyword(s):  
Monoamine Oxidase ◽  
Tricyclic Antidepressants ◽  
Monoamine Oxidase Inhibitor ◽  
Relative Effectiveness ◽  
Hypertensive Crisis ◽  
Oxidase Inhibitor ◽  
Monoamine Oxidase A ◽  
Pressor Test ◽  
The World ◽  
Tyramine Pressor Test

The hypertensive crisis induced by the ingestion of cheese in subjects undergoing treatment with monoamine oxidase inhibitors (MAOIs) led to their virtual disappearance in many parts of the world. Three strategies to try and diminish the risk of this reaction have been developed: the combination of current (irreversible and non-selective) MAOIs with tricyclic antidepressants, the use of new selective MAOIs, and the use of new reversible MAOIs. The relative effectiveness of these different approaches can be assessed by the tyramine pressor test. The introduction of reversible and selective monoamine oxidase-A (MAO-A) inhibitors looks especially promising clinically.

Phase II trial of monoamine oxidase inhibitor phenelzine in biochemical recurrent prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 94-94 ◽  
Author(s):  
Mitchell E. Gross ◽  
David B. Agus ◽  
Tanya B. Dorff ◽  
Jacek K. Pinski ◽  
David I. Quinn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trial ◽  
Monoamine Oxidase ◽  
Monoamine Oxidase Inhibitor ◽  
Depression Score ◽  
Oxidase Inhibitor ◽  
Monoamine Oxidase A ◽  
Recurrent Prostate Cancer ◽  
Open Label ◽  
Grade 3

94 Background: Monoamine oxidase A (MAOA) influences prostate cancer growth and metastasis in pre-clinical models. We examined effects of phenelzine (a monoamine oxidase inhibitor) in patients with biochemical recurrent castrate-sensitive prostate cancer. Methods: An open-label single arm clinical trial enrolled subjects with biochemical recurrent prostate cancer defined by: PSA ≥ 0.4 ng/ml (post-prostatectomy) or PSA ≥ 2 ng/ml above nadir (post-radiation therapy); no evidence of metastasis on imaging; and normal androgen levels. Subjects received phenelzine 30 mg orally twice daily. Mood symptoms were assessed with the hospital anxiety depression score (HADS) questionnaire. The primary endpoint was the proportion of patients who achieved a PSA decline of ≥50% from baseline. Results: Characteristics of the 20 eligible patients enrolled included: mean ± SD age 66.9 ± 4.8 years and PSA 4.7 ± 5.8 ng/dl. Maximal PSA declines ≥ 30% and ≥ 50% were observed in 25% (n=5/20) and 10% (n=2/20) of subjects, respectively. At 12 weeks, 17 subjects remained on treatment with PSA declines ≥ 30% and ≥ 50% of 24% (n=4/17) and 6% (n=1/17), respectively. Common toxicities observed included dizziness (grade 1 = 45%, grade 2= 35%), hypertension (grade ≥ 2 =30%), and edema (grade 1=25%, grade 2=10%). There was 1 episode of grade 4 hypertension (cycle 4) and 2 episodes of grade 3 syncope (cycle 12 and cycle 14) requiring treatment discontinuation. HADS questionnaires demonstrated a significant decrease in anxiety with no change in depressive symptoms on treatment. Conclusions: Phenelzine demonstrated efficacy in patients with biochemical recurrent castrate sensitive prostate cancer. Most treatment related toxicities were mild, but rare significant and reversible cardiovascular toxicities were observed. Therapies directed at MAOA may represent a new avenue for treatment in patients with recurrent prostate cancer. Clinical trial information: NCT02217709.

Are Antidepressants All the Same? Surveying the Opinions of Australian Psychiatrists

1999 ◽  
Vol 33 (5) ◽  
pp. 642-649 ◽  
Author(s):  
Ian B. Hickie ◽  
Elizabeth M. Scott ◽  
Tracey A. Davenport
Keyword(s):  
Clinical Practice ◽  
Major Depression ◽  
Monoamine Oxidase ◽  
Serotonin Receptor ◽  
Monoamine Oxidase Inhibitor ◽  
Oxidase Inhibitor ◽  
Receptor Subtype ◽  
Reversible Inhibitors ◽  
Uptake Inhibitors ◽  
Wide Range

Objective: Controlled trials do not suggest differences in efficacy between antidepressant compounds. Psychiatrists, however, frequently express the view that real differences do exist and are relevant to clinical practice. Since multiple comparative trials are not feasible, an alternative method for expanding the evidence base is to survey regularly the opinions of practising psychiatrists. Method: Two surveys of psychiatrists' opinions were conducted. Participants in the first survey were drawn from contact with ‘SPHERE: A National Depression Project’, while those in the second survey responded to a brief questionnaire distributed with Australasian Psychiatry. Results: Reported volumes of scripts written, ratings of efficacy and tolerability, and preferences in specific clinical situations indicate that clinical psychiatrists now strongly prefer the newer antidepressant agents. They rate serotonin and noradren-alin re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs) highest for antidepressant efficacy, serotonin receptor subtype 2 (5HT2) antagonists and some SSRIs highest for anti-anxiety efficacy, and some SSRIs and reversible inhibitors of monoamine oxidase inhibitor-A (RIMAs) lowest for side-effect burden. Further, SSRIs were their first preferences for most clinical situations. Serotonin and noradrenalin re-uptake inhibitors were the preferred choice for treatment-resistant depression and patients who had failed to respond to one SSRI. Serotonin receptor subtype 2 antagonists were the second choice to SSRIs for mixed anxiety and depression, and major depression with sleep disturbance. Reversible inhibitors of monoamine oxidase inhibitor-A were the second choice to SSRIs for adolescents with major depression, patients aged over 65 years, patients with serious medical illnesses and patients with chronic fatigue. Tricyclic antidepressants (TCAs) were the preferred choice for patients with chronic pain, and second choice to SSRIs for patients with major depression with panic disorder, postnatal disorders and patients with psychotic depression. Conclusion: Psychiatrists believe that important differences do exist between available antidepressant compounds. Such opinions are divergent from limited controlled data but may be influenced by a wide range of factors other than direct clinical experience. The role of such surveys in ongoing evaluation of clinical practice is emphasised.

scholarly journals Strategies for Managing Depression Refractory to Selective Serotonin Reuptake Inhibitor Treatment: A Survey of Clinicians

2000 ◽  
Vol 45 (5) ◽  
pp. 476-481 ◽  
Author(s):  
David Mischoulon ◽  
Andrew A Nierenberg ◽  
Leena Kizilbash ◽  
Jerrold F Rosenbaum ◽  
Maurizio Fava
Keyword(s):  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Monoamine Oxidase Inhibitor ◽  
Oxidase Inhibitor ◽  
Tricyclic Antidepressant ◽  
Selective Serotonin ◽  
Treatment Practices ◽  
Group Settings ◽  
First Choice

Objective: To examine treatment practices in cases where selective serotonin reuptake inhibitors (SSRIs) are ineffective. Methods: We surveyed 801 clinicians (including 630 psychiatrists) attending the Massachusetts General Hospital's annual psychopharmacology review course. Clinicians were presented with a vignette about a patient with depression who had responded partially to an SSRI and were asked to choose among various strategies available to manage this patient. Results: Of those surveyed, 466 clinicians had been in practice a mean of 16.6 years (SD 10.7). Not all clinicians chose to answer every question. Among 455 respondents, 84% (n = 382) chose to increase the dose of the SSRI, 10% (n = 47) chose augmentation or combination, and 7%(n = 31) opted for switching agents. When asked to switch to another agent, 448 responded, of whom 52% (n = 235) chose a newer antidepressant, 34% (n = 152) chose another SSRI, 10%(n = 44) chose a tricyclic antidepressant (TCA), 2%(n = 8) chose a serotonin norepinephrine reuptake inhibitor (SNRI), 1% (n = 5) chose a monoamine oxidase inhibitor (MAOI), and 1% (n = 4) chose an undefined “other” agent. Among 445 respondents, bupropion was the most widely chosen augmenting agent (30%, n = 134), followed by lithium (22%, n = 98). West coast and Canadian clinicians preferred to switch to another SSRI rather than to a newer antidepressant. Canadian clinicians preferred lithium to bupropion as their first-choice augmenting agent, as did clinicians from academic settings. Clinicians from community, individual practice, or group settings favoured bupropion. More experienced clinicians preferred bupropion as a first-choice augmenter, whereas less experienced ones showed a slight preference for lithium. Canadian clinicians were more likely to use MAOIs as second-line agents. Conclusions: Clinicians in this sample often followed strategies different from those recommended in the literature. Bupropion may have an important role in augmentating treatment with SSRIs.

The treatment of anxiety disorders: a legacy of William Sargant

1997 ◽  
Vol 12 (8) ◽  
pp. 381-386
Author(s):  
MG Gelder
Keyword(s):  
Monoamine Oxidase ◽  
Anxiety Disorders ◽  
Mode Of Action ◽  
Monoamine Oxidase Inhibitor ◽  
Oxidase Inhibitor ◽  
Tricyclic Antidepressant ◽  
Psychological Treatments ◽  
Therapeutic Value ◽  
Chronic Anxiety ◽  
Made In

SummaryIn 1962 William Sargant and his colleagues described the therapeutic value of phenelzine, a monoamine oxidase inhibitor (MAOI), in chronic anxiety disorders and in the same year Klein and Fink reported the treatment of similar conditions with imipramine, a tricyclic antidepressant. Subsequent research has confirmed these findings and demonstrated the range of similar drugs that are effective in anxiety disorders. At the time of these original observations about the drug treatment of anxiety, there were no psychological treatments of proven value but in the intervening years much progress has been made in developing behavioural and cognitive procedures. The progress in determining the mode of action of these pharmacological and psychological treatments is reviewed and the implications of the findings are considered in relation to research into the causes of the anxiety disorders and to the treatment of patients.

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