Subject(s)
Fear/drug effects , Imipramine/therapeutic use , Panic/drug effects , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Schizophrenic Psychology , Adult , Benztropine/analogs & derivatives , Benztropine/therapeutic use , Clinical Trials as Topic , Double-Blind Method , Drug Therapy, Combination , Female , Fluphenazine/analogs & derivatives , Fluphenazine/therapeutic use , HumansABSTRACT
Forty-six schizophrenic or schizoaffective patients with operationally defined episodes of postpsychotic depression were assessed for previous histories of substance abuse. Thirty-five percent had histories of previous cannabis (marijuana) abuse. Additionally, 13% had also abused cocaine, 13% amphetamines, 11% hallucinogens, 4% sedatives, and 2% opiates. Patients with histories of substance abuse were younger and showed higher index ratings on a subscale of endogenous depressive features. These findings are considered in the context of a possible self-medication hypothesis of substance abuse. A history of substance abuse did not appear to be a contraindication to a therapeutic trial of adjunctive imipramine (Ciba Geigy Corp., Summit, NJ) for postpsychotic depression.
Subject(s)
Depressive Disorder/psychology , Schizophrenic Psychology , Substance-Related Disorders/psychology , Adult , Clinical Trials as Topic , Depressive Disorder/drug therapy , Double-Blind Method , Female , Humans , Imipramine/therapeutic use , Male , Random Allocation , Risk FactorsABSTRACT
Adjunctive imipramine has been found to be useful in the treatment of a substantial number of patients with syndromally defined post-psychotic depressions. This paper examines the clinical effects of the combined anticholinergic activity of imipramine, when added to ongoing fluphenazine decanoate/benztropine treatment, in such patients. Little additional anticholinergic impact of the imipramine was observable beyond that already attributable to the benztropine, and no significant relationships were found between a clinical measure of peripheral anticholinergic activity and either global clinical outcome or antidepressive efficacy. This paper also reports on the concentrations of imipramine and its metabolites in plasma under the conditions of this therapeutic trial. The changes in relative concentrations of imipramine and metabolites with time were consistent with the concept that fluphenazine competes with tricyclic metabolism. The relationship of plasma imipramine and desipramine to clinical improvement in this group of secondary depressions did not parallel previously reported relationships of these antidepressant molecules to clinical outcome in primary depressions.
