Paroxetine and imipramine in the treatment of depressive patients in psychiatric practice.

A total of 151 outpatients with endogenous or mixed endogenous and reactive depression were included in a 6-week double-blind study, with extension for up to 1 year, in psychiatric practice. The results showed trends in efficacy variables and a statistically significant difference in a benefit-risk ratio in favour of paroxetine (Seroxat, Paxil) compared with imipramine. Efficacy was largely maintained in both groups during long-term treatment. The frequency and severity of side effects in paroxetine patients declined markedly from short-term to long-term treatment, whereas changes in imipramine patients were less pronounced. Significantly more imipramine patients gained weight during long-term treatment. In conclusion, paroxetine is an effective and well tolerated antidepressant, well suited for outpatients in psychiatric practice.

Combined treatment with imipramine and mianserin. A controlled pilot study.

The effect of imipramine plus mianserin and imipramine plus a placebo was compared in 40 depressed patients with a median age of 60 years. The imipramine dosage was flexible to give a plasma concentration around 200 nmol/l and mianserin was given at a fixed dosage of 30 mg daily. After six weeks of treatment the results showed that the scores on the Hamilton Depression Scale as well as on the Melancholia Scale were significantly more improved in the imipramine-plus-minaserin group than in the group of patients receiving imipramine alone (P less than 0.01). In terms of percentage of improvement (a reduction of baseline rating scores of 50% or more) 77% of the imipramine-plus-mianserin group had improved, compared with 27% of the imipramine group. The combination of imipramine and mianserin was well tolerated both as regards clinical side-effects and laboratory tests.

Imipramine binding in depressed patients with psychogenic pain.

Imipramine binding to platelet membranes from depressed patients was analyzed. The patients were divided into two groups: one with depression alone, another with depression and psychogenic pain. The depressed patients with psychogenic pain had lower imipramine binding than the depressed patients without pain.

Clomipramine and mianserin in the treatment of chronic tension headache. A double-blind, controlled study.

114 patients with chronic tension headache (more than 10 days per month for at least 6 months) were treated with placebo, clomipramine or mianserin in a double blind parallel group comparison. Eighty-two patients completed the study. Headache pain was scored weekly on visual analogue scales for the 6 weeks of treatment. Observer-rating of headache was made at entry, after 3 weeks and after 6 weeks of treatment. In all groups, headache complaints decreased significantly compared to baseline. With the main parameter the decrease on both clomipramine and mianserin was significant compared to placebo. Although the trend was the same for the other parameters, the changes relative to placebo did not reach statistical significance.

Plasma ratio tryptophan/neutral amino acids in relation to clinical response to paroxetine and clomipramine in patients with major depression.

The pretreatment plasma ratio of tryptophan (Trp) to other large neutral amino acids (LNAA), thought to reflect brain serotonin formation, was determined in 44 inpatients with major depression, who were subsequently treated double-blind on a fixed-dose schedule for 4 weeks with the selective serotonin uptake inhibitor paroxetine (n = 27) or clomipramine (n = 17). The study took place at four clinical centers. Endogenous and non-endogenous depressives were comparable with respect to the ratio Trp/LNAA and clinical improvement and were therefore analyzed together. The clomipramine group showed a significant inverse correlation between ratio Trp/LNAA and improvement, and patients with a ratio Trp/LNAA below the mean showed a trend towards greater improvement than patients with a higher ratio but with comparable serum drug levels. The improvement in the paroxetine group was significantly inversely correlated with the Trp concentration but not with the ratio Trp/LNAA. The findings accord with previous trials of various antidepressant treatments, in which about 25% of the variance in therapeutic response associates with pretreatment plasma amino acid profiles.

Clomipramine and mianserin in chronic idiopathic pain syndrome. A placebo controlled study.

The reduction of pain by two antidepressants, clomipramine and mianserin, was, in this study on 253 patients with chronic idiopathic pain syndrome, found to be not better than a placebo when all patients were compared independently of the classification of pain. The improvement rate was around 40% after 6 weeks of treatment when using a 50% or better reduction in pain level. However, in patients who fulfilled a checklist definition of minor to major depression (30% of the total patient material) clomipramine was superior to mianserin and placebo with an improvement rate of 75% after 6 weeks. Using pain curves over time as outcome measure in the various clinical pain categories it was found that both mianserin and clomipramine seemed superior to placebo in patients with tension headache, but in patients with low back pain syndrome placebo was superior to the two antidepressants. No difference among the three treatments was found in patients with burning mouth syndrome or in patients with abdominal pain. These differences underline the importance of studying specific pain syndromes rather than composite groups of patients with idiopathic pain. The clinical significance of these pain curves needs further placebo controlled investigations.

Platelet 3H-imipramine binding in psychogenic pain patients.

High-affinity binding of 3H-imipramine was analyzed in platelet membranes from patients with chronic psychogenic pain. The patients who in addition to the pain also showed affective symptoms such as depression and anxiety had lower binding than the pain patients without these symptoms.

Use of headache rating scales: a multiaxial approach.

The basic principles of the rating scale procedure have been outlined, including the Likert scale, the Guilford criteria for item definitions, and the Guttman and Rasch criteria for item combinations. With these criteria, headache rates among the core symptoms of anxiety and depression. Next, we have discussed one of the prevailing scales for headache, the Waters Headache Questionnaire (WHQ), with a multiaxial approach. The WHQ thus contains a severity axis, a diagnostic axis, and a personality axis. Previous studies on the validity of the WHQ, including factor analysis, have shown that migraine and muscular headaches are not mutually exclusive categories. Studies to validate a two-dimensional diagnostic system of migraine and non-migraine headache by Rasch models are discussed. In the field of personality it was suggested, when using questionnaires like the WHQ, to focus on the concepts of acquiescence and dissimulation. Supplemental axes such as "severity of psychosocial stressors" and "social functioning" or "quality of life" should be considered in future research.