Characterization of C3h]Desipramine Binding Associated with Neuronal Norepinephrine Uptake Sites in Rat Brain Membranes’
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Differential Effects on Suicidal Ideation of Mianserin, Maprotiline and Amitriptyline S
Br. J. clin. Pharmac. (1978), 5, 77S-80S DIFFERENTIAL EFFECTS ON SUICIDAL IDEATION OF MIANSERIN, MAPROTILINE AND AMITRIPTYLINE S. MONTGOMERY Academic Department of Psychiatry, Guy's Hospital Medical School, London Bridge, London SE1 9RT, UK B. CRONHOLM, MARIE ASBERG Karolinska Institute, Stockholm D.B. MONTGOMERY Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, U K 1 Eighty patients suffering from primary depressive illness were treated for 4 weeks, following a 7-d (at least) no-treatment period, with either mianserin 60 mg daily (n = 50), maprotiline 150 mg at night- time (n = 15) or amitriptyline 150 mg at night-time (n = 15) in double-blind controlled trials run con- currently in the same hospital on protocols having the same design and entry criteria. 2 The effects of the three drugs were examined for their proffle of action using a new depression rating scale (Montgomery and Asberg Depression Scale, MADS) claimed to be more sensitive to change. There was no significant difference in mean entry scores or mean amelioration of depression on the MADS or the Hamilton Rating Scale (HRS) between the three drugs, but individual items on the MADS did show significant differences in amelioration. A highly significant (P < 0.01) difference was observed in favour of mianserin against maprotiline on both items of'suicidal thoughts' and 'pessimistic thoughts' on the MADS. The suicidal item on the HRS showed a similar tendency which did not reach significance. 3 This finding is considered in relation to a possible mode of action of mianserin and the relevance to reported subgroups ofdepressive illness with increased suicidal ideation. -
Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW
Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW Name of Medicine / Trimipramine (Surmontil®) Class (generic and brand) Licensed indication(s) Treatment of depressive illness, especially where sleep disturbance, anxiety or agitation are presenting symptoms. Sleep disturbance is controlled within 24 hours and true antidepressant action follows within 7 to 10 days. Licensed dose(s) Adults: For depression 50-75 mg/day initially increasing to 150-300 mg/day in divided doses or one dose at night. The maintenance dose is 75-150 mg/day. Elderly: 10-25 mg three times a day initially. The initial dose should be increased with caution under close supervision. Half the normal maintenance dose may be sufficient to produce a satisfactory clinical response. Children: Not recommended. Purpose of Document To review information currently available on this class of medicines, give guidance on potential use and assign a prescribing classification http://www.cambsphn.nhs.uk/CJPG/CurrentDrugClassificationTable.aspx Annual cost (FP10) 10mg three times daily: £6,991 25mg three times daily: £7,819 150mg daily: £7,410 300mg daily: £14,820 Alternative Treatment Options within Class Tricyclic Annual Cost CPCCG Formulary Classification Antidepressant (FP10) Amitriptyline (75mg) Formulary £36 Lofepramine (140mg) Formulary £146 Imipramine (75mg) Non-formulary £37 Clomipramine (75mg) Non-formulary £63 Trimipramine (75mg). TBC £7,819 Nortriptyline (75mg) Not Recommended (pain) £276 Doxepin (150mg) TBC £6,006 Dosulepin (75mg) Not Recommended (NICE DO NOT DO) £19 Dosages are based on possible maintenance dose and are not equivalent between medications Recommendation It is recommended to Cambridgeshire and Peterborough CCG JPG members and through them to local NHS organisations that the arrangements for use of trimipramine are in line with restrictions agreed locally for drugs designated as NOT RECOMMENDED:. -
LUMIN Mianserin Hydrochloride Tablets
AUSTRALIAN PRODUCT INFORMATION LUMIN Mianserin hydrochloride tablets 1 NAME OF THE MEDICINE Mianserin hydrochloride 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Mianserin belongs to the tetracyclic series of antidepressant compounds, the piperazinoazepines. These are chemically different from the common tricyclic antidepressants. Each Lumin 10 tablet contains 10 mg of mianserin hydrochloride and each Lumin 20 tablet contains 20 mg of mianserin hydrochloride as the active ingredient. Lumin also contains trace amounts of sulfites. For the full list of excipients, see Section 6.1 List of Excipients. 3 PHARMACEUTICAL FORM Lumin 10: 10 mg tablet: white, film coated, normal convex, marked MI 10 on one side, G on reverse Lumin 20: 20 mg tablet: white, film coated, normal convex, marked MI 20 on one side, G on reverse 4 CLINICAL PARTICULARS 4.1 THERAPEUTIC INDICATIONS For the treatment of major depression. 4.2 DOSE AND METHOD OF ADMINISTRATION Lumin tablets should be taken orally between meals, preferably with a little fluid, and swallowed without chewing. Use in Children and Adolescents (< 18 years of age) Lumin should not be used in children and adolescents under the age of 18 years (see section 4.4 Special Warnings and Precautions for use). Adults The initial dosage of Lumin should be judged individually. It is recommended that treatment begin with a daily dose of 30 mg given in three divided doses or as a single bedtime dose and be adjusted weekly in the light of the clinical response. The effective daily dose for adult patients usually lies between 30 mg and 90 mg (average 60 mg) in divided doses or as a single bedtime dose. -
Fatal Toxicity of Antidepressant Drugs in Overdose
BRITISH MEDICAL JOURNAL VOLUME 295 24 OCTOBER 1987 1021 Br Med J (Clin Res Ed): first published as 10.1136/bmj.295.6605.1021 on 24 October 1987. Downloaded from PAPERS AND SHORT REPORTS Fatal toxicity of antidepressant drugs in overdose SIMON CASSIDY, JOHN HENRY Abstract dangerous in overdose, thus meriting investigation of their toxic properties and closer consideration of the circumstances in which A fatal toxicity index (deaths per million National Health Service they are prescribed. Recommendations may thus be made that prescriptions) was calculated for antidepressant drugs on sale might reduce the number offatalities. during the years 1975-84 in England, Wales, and Scotland. The We used national mortality statistics and prescription data tricyclic drugs introduced before 1970 had a higher index than the to compile fatal toxicity indices for the currently available anti- mean for all the drugs studied (p<0-001). In this group the depressant drugs to assess the comparative safety of the different toxicity ofamitriptyline, dibenzepin, desipramine, and dothiepin antidepressant drugs from an epidemiological standpoint. Owing to was significantly higher, while that ofclomipramine, imipramine, the nature of the disease these drugs are particularly likely to be iprindole, protriptyline, and trimipramine was lower. The mono- taken in overdose and often cause death. amine oxidase inhibitors had intermediate toxicity, and the antidepressants introduced since 1973, considered as a group, had significantly lower toxicity than the mean (p<0-001). Ofthese newer drugs, maprotiline had a fatal toxicity index similar to that Sources ofinformation and methods of the older tricyclic antidepressants, while the other newly The statistical sources used list drugs under their generic and proprietary http://www.bmj.com/ introduced drugs had lower toxicity indices, with those for names. -
Association of Selective Serotonin Reuptake Inhibitors with the Risk for Spontaneous Intracranial Hemorrhage
Supplementary Online Content Renoux C, Vahey S, Dell’Aniello S, Boivin J-F. Association of selective serotonin reuptake inhibitors with the risk for spontaneous intracranial hemorrhage. JAMA Neurol. Published online December 5, 2016. doi:10.1001/jamaneurol.2016.4529 eMethods 1. List of Antidepressants for Cohort Entry eMethods 2. List of Antidepressants According to the Degree of Serotonin Reuptake Inhibition eMethods 3. Potential Confounding Variables Included in Multivariate Models eMethods 4. Sensitivity Analyses eFigure. Flowchart of Incident Antidepressant (AD) Cohort Definition and Case- Control Selection eTable 1. Crude and Adjusted Rate Ratios of Intracerebral Hemorrhage Associated With Current Use of SSRIs Relative to TCAs eTable 2. Crude and Adjusted Rate Ratios of Subarachnoid Hemorrhage Associated With Current Use of SSRIs Relative to TCAs eTable 3. Crude and Adjusted Rate Ratios of Intracranial Extracerebral Hemorrhage Associated With Current Use of SSRIs Relative to TCAs. eTable 4. Crude and Adjusted Rate Ratios of Intracerebral Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak eTable 5. Crude and Adjusted Rate Ratios of Subarachnoid Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak eTable 6. Crude and Adjusted Rate Ratios of Intracranial Extracerebral Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak This supplementary material has been provided by the authors to give readers additional information about their work. © 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 eMethods 1. -
Summary of Product Characteristics
Irish Medicines Board Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT Mianserin 30 mg Film -coated tablets 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 30 mg mianserin hydrochloride. For a full list of excipients, see section 6.1. 3 PHARMACEUTICAL FORM Film -coated tablet (tablet) White, circular, film -coated, biconvex tablets, about 8 mm in diameter, marked ‘MI 30 ’ on one face and ‘G’ on the reverse. 4 CLINICAL PARTICULARS 4.1 Therapeutic Indications For the treatment of primary depressive illness, (e.g. endogenous depression, reactive depression, involutional melancholia, depression in association with physical complaints). In those cases where marked anxiety or insomnia is a predominant feature of depressive illness, mianserin may be effective without concomitant tranquillizing treatment. 4.2 Posology and method of administration Oral. The tablets should be swallowed whole without chewing, preferably with some fluid. Adults Clinical treatment should be started with 30 mg daily and the dosage adjusted by the clinical reaction. The daily effective dose in adults usually lies between 30 to 90 mg. The total daily dose may be given either as a single night - time dose or divided into three sub -doses. Elderly Patients An initial dose of 30 mg daily may be slowly increased under close supervision. Mianserin has a longer half life and slower metabolite clearance in the elderly. Children and adolescents Mianserin should not be used in the treatment of children and adolescents under the age of 18 years (see section 4.4 Special Warnings and Precautions for Use) 4.3 Contraindications Mania, use during pregnancy and lactation, use in children and severe liver disease. -
Print This Article
International Journal of Advances in Medicine Kumar MS et al. Int J Adv Med. 2021 Oct;8(10):1551-1559 http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933 DOI: https://dx.doi.org/10.18203/2349-3933.ijam20213642 Original Research Article Effectiveness and tolerability of eight-week treatment with dosulepin hydrochloride in patients with major depressive disorder not responding to four consecutive weeks of treatment with single selective serotonin reuptake inhibitor M. Suresh Kumar1*, Amrit Pattojoshi2 1PSYMED Hospital, Harrington Road, Shenoy Nagar, Chennai, Tamil Nadu, India 2Dr. Amrit Pattojoshi's Clinic, Bhouma Nagar, Bhubaneswar, Odisha, India Received: 12 August 2021 Accepted: 23 August 2021 *Correspondence: Dr. M. Suresh Kumar, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Though manageable, major depressive disorder remains an underdiagnosed and undertreated condition. The objective of this study was to assess the effectiveness and safety of 8 weeks of treatment with the tricyclic antidepressant dosulepin hydrochloride in patients with depressive episodes not responsive to 4 consecutive weeks of treatment with a single selective serotonin reuptake inhibitor (SSRI). Methods: Patients diagnosed with depressive episode without psychotic symptoms (by ICD-10 diagnostic criteria for research), mini-mental state examination score of ≥24, and not responsive to four weeks of treatment with SSRIs (<50% reduction in depressive symptoms) were enrolled. The main outcome measures were mean change in the Hamilton depression, Hamilton anxiety, and insomnia severity index scores at Week 8 compared to baseline. -
Norepinephrine in Rat Brain Slices
V~,,,rophnnr,uroloq! Vol. 10. pp. 363 to 369. 1981 001X-390X XI 040362-07102.00 0 Printed in Great Britain Prrgsmon Press Ltd THE EFFECTS OF ANTIDEPRESSANTS ON THE RETENTION AND METABOLISM OF [3H]-NOREPINEPHRINE IN RAT BRAIN SLICES F. T. CREWS* and C. B. SMITH Department of Pharmacology. The University of Michigan Medical School, Ann Arbor. MI 48109. U.S.A. (Accepted 20 Sepremher 1980) Summary-Tricylic antidepressants acutely decrease the neuronal retention of C3H]-norepinehrine (C3H]-NE) by blocking neuronal membrane uptake and/or vesicular uptake and binding. To distinguish between effects upon the plasma membrane and upon the vesicular membrane, the retention, deamina- tion. and O-methylation of [jH]-NE by rat brain slices were investigated in the presence of several antidepressant agents. The effects of antidepressants were compared to those of the prototype inhibitors. cocaine and reserpine. using slices of hypothalamus, brainstem. parietal cortex and caudate nucleus. Cocaine, which inhibits neuronal membrane uptake, decreased both the deamination and retention of C3H]-NE. while 0-methylation was increased. Reserpine. which inhibits vesicular transport and binding, increased deamination, while it reduced retention without affecting the 0-methylation of [‘HI-NE. The effects of desipramine. a prototype tricyclic antidepressant, were found to depend on the concentration. At low concentrations (10-9-10-sM). desipramine inhibited the retention and deamination of C3H]-NE in each brain region except the caudate. At higher concentrations (10-7-10-4M), the retention of C3H]-NE was reduced further. However, deamination was increased in the caudate and, in the other three repions, deamination did not decrease further. -
Tricyclic Antidepressants Versus
Jørgensen et al. Syst Rev (2021) 10:227 https://doi.org/10.1186/s13643-021-01789-0 PROTOCOL Open Access Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis Caroline Kamp Jørgensen1* , Sophie Juul1,2,3, Faiza Siddiqui1, Marija Barbateskovic1, Klaus Munkholm4, Michael Pascal Hengartner5, Irving Kirsch6, Christian Gluud1 and Janus Christian Jakobsen1,7 Abstract Background: Major depressive disorder is a common psychiatric disorder causing great burden on patients and societies. Tricyclic antidepressants are frequently used worldwide to treat patients with major depressive disorder. It has repeatedly been shown that tricyclic antidepressants reduce depressive symptoms with a statistically signifcant efect, but the efect is small and of questionable clinical importance. Moreover, the benefcial and harmful efects of all types of tricyclic antidepressants have not previously been systematically assessed. Therefore, we aim to investigate the benefcial and harmful efects of tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder. Methods: This is a protocol for a systematic review with meta-analysis that will be reported as recommended by Pre- ferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, bias will be assessed with the Cochrane Risk of Bias tool—version 2, our eight-step procedure will be used to assess if the thresholds for clinical signifcance are crossed, Trial Sequential Analysis will be conducted to control random errors and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. -
Jaundice Due to Iprindole
Gut: first published as 10.1136/gut.12.9.705 on 1 September 1971. Downloaded from Gut, 1971, 12, 705-708 Jaundice due to iprindole A. B. AJDUKIEWICZ, J. GRAINGER, P. J. SCHEUER, AND S. SHERLOCK From the Departments of Medicine and Pathology, Royal Free Hospital, London SUMMARY Twenty-one patients treated for depression with iprindole developed evidence of liver damage: 15 were jaundiced, five had bilirubinuria, and one had pruritus. These complications occurred between four and 21 days after initial exposure to the drug. All patients recovered. Light and electron microscopic findings in liver biopsies of one of these patients were those of cholestasis without inflammation. Antidepressants are among the most commonly pre- she developed headache, fever, giddiness, and sweat- scribed drugs. Approximately 15% of all prescrip- ing, and three days later she noticed that her eyes tions written in Britain in recent years have been for were yellow and so stopped the iprindole. There had psychotropic drugs (Dunlop, 1969). Iprindole been no nausea, vomiting, or abdominal pain. The (Prondol) was introduced in the early 1960s and is a jaundice persisted and was associated with pruritus, commonly used antidepressant which is claimed to dark urine, and pale stools. She had had no blood have few side effects. The two patients to be reported transfusions, no other drugs, and no contact with a in detail were both treated with iprindole for depres- jaundiced person. Alcohol intake had been minimal. sion and developed a hepatic reaction; in one of Two months after starting iprindole she was admit- these, liver biopsies were taken for light and electron ted to hospital. -
The Influence of Sex Hormones on Antidepressant- Induced Alterations in Neurotransmiti’Er Receptor Binding’
0270~fS74/82/0203-0354$02.00/O The Journal of Neuroscience Copyright 0 Society for Neuroscience Vol. 2, No. 3, pp. 354-360 Printed in U.S.A. March 1982 THE INFLUENCE OF SEX HORMONES ON ANTIDEPRESSANT- INDUCED ALTERATIONS IN NEUROTRANSMITI’ER RECEPTOR BINDING’ DAVID A. KENDALL, GEORGE M. STANCEL, AND S. J. ENNA’ Departments of Pharmacology and of Neurobiology and Anatomy, University of Texas Medical School at Houston, Houston, Texas 77025 Received August 24, 1981; Revised November 2, 1981; Accepted November 6, 1981 Abstract Long term (21-day) treatment with antidepressants induces a decrease in P-adrenergic and serotoninz (5HTz) receptor binding in rat brain frontal cortex. Since hormone imbalances are known to be associated with affective illness, the present study was undertaken to determine whether sex hormones influence these alterations in neurotransmitter receptor binding. Using receptor binding assays, we found that castration abolishes the decline in the concentration of 5-HTZ, but not p- adrenergic, receptors brought on by chronic imipramine or iprindole treatment in both male and female rats. In contrast, the receptor responses to trazodone, mianserin, and pargyline were not influenced by surgery. Furthermore, mianserin was found to reduce /3-adrenergic binding in intact females, but not males, suggesting a sex-related specificity with regard to the response to this agent. Testosterone and estrogen, but not dihydrotestosterone, reversed the effects of castration in males, suggesting that the interaction between the steroids and antidepressants is mediated through estrogenic, rather than androgenic, receptors. The results indicate that the receptor responses to some antidepressant drugs is dependent, at least in part, on the hormonal state of the animal. -
II.3.3 Tricyclic and Tetracyclic Antidepressants by Akira Namera and Mikio Yashiki
3.3 II.3.3 Tricyclic and tetracyclic antidepressants by Akira Namera and Mikio Yashiki Introduction Many of antidepressants exert their eff ects by inhibiting the reuptake of norepinephrine and serotonin and by accerelating the release of them at synaptic terminals of neurons in the brain. As characteristic structures of such drugs showing antidepressive eff ects, many of them have tricyclic or tetracyclic nuclei; this is the reason why they are called “ tricyclic antidepressants or tetracyclic antidepressants”. Th ere are many cases of suicides using the antidepressants; their massive intake sometimes causes death. About 10 kinds of tricyclic and tetracyclic antidepressants are now being used in Japan (> Figure 3.1); among them, amitriptyline is best distributed [1, 2]. Recently, the use of tetracyclic antidepressants is increasing, because of their mild side eff ects and their high eff ectiveness with their small doses; the increase of their use is causing the increase of their poisoning cases. Although carbamazepine does not belong to the antidepressant group, its structure is very similar to those of tricyclic antidepressants; therefore, the drug is also in- cluded in this chapter. GC/MS analysis Reagents and their preparation • Amitriptyline, carbamazepine, clomipramine, desipramine, imipramine, maprotiline, mi- anserin, nortriptyline and trimipramine can be purchased from Sigma (St. Louis, MO, USA); pure powder of the following drugs was donated by each manufacturer: amoxapine by Takeda Chem. Ind. Ltd., Osaka, Japan; dosulepin by Kaken Pharmaceutical Co., Ltd., Tokyo, Japan; lofepramine by Daiichi Pharmaceutical Co., Ltd., Tokyo, Japan; and setip- tiline by Mochida Pharmaceutical Co., Ltd., Tokyo, Japan. • A 20-g aliquot of sodium carbonate is dissolved in distilled water to prepare 100 mL solu- tion (20 %, w/v).