Indalpine, a specific 5HT uptake inhibitor, in delusional depression

Risk of psychosis exacerbation by tricyclic antidepressants in unipolar Major Depressive Disorder with psychotic features

BACKGROUND

We conducted a systematic review of the published trials in unipolar Major Depressive Disorder with psychotic features (MDDP) to examine the risk of psychosis exacerbation by antidepressants.

METHODS

We searched Medline, Cochrane Central Register of Controlled Trials, PsychINFO, and EMBASE for English language, controlled, open or retrospective acute antidepressant and/or antipsychotic treatment studies of unipolar MDDP. Studies without a clear delineation of treatment course or between bipolar disorder and unipolar MDDP were excluded. We evaluated studies for the number of subjects with psychosis exacerbation, and contacted the corresponding author for ambiguous cases. Studies in which we were unable to determine rates of psychosis exacerbation were excluded. Psychosis exacerbation was determined on a categorical basis, and analyzed with Fisher's exact test, a modified Wald confidence interval and odds ratio.

RESULTS

20 studies meeting criteria provided sufficient adverse event reporting for inclusion. 15 of 177 subjects (8.5%) on antidepressant monotherapy had a psychosis exacerbation, 8 of whom were on tricyclics. 2 of 129 subjects on either antipsychotic or combination treatment had a psychosis exacerbation. Tricyclic monotherapy was significantly more likely to be temporally associated with psychosis exacerbation (p=0.007).

LIMITATIONS

Limitations include the small number of placebo-controlled trials, and numerous studies in which the relevant information was missing. Additionally, most trials were designed as treatment outcome studies, and not to determine the rate of psychosis exacerbation.

CONCLUSIONS

Although rare, the present study indicates that tricyclic monotherapy may be temporally associated with an exacerbation of psychotic symptoms in patients with unipolar MDDP, potentially worsening prognosis.

Effect of subchronic treatment with imipramine, chlorpromazine and the combination on 3H-imipramine binding in rat blood platelets and frontal cortex

The effects of subchronic administration of imipramine (IMIP), chlorpromazine (CPZ) and the combination of IMIP + CPZ on 3H-IMIP binding of rat blood platelets and cortex were studied. All three treatments decreased the number of IMIP binding sites (Bmax) of rat blood platelets and cortex. The combination produced a significantly greater decrease in Bmax in platelets than either treatment alone; a similar trend in cortex was observed. The effect of some neuroleptics on 3H-IMIP binding sites may be relevant to their antidepressant action. These results, together with previous evidence that the combination has a synergistic effect on down regulation of brain serotonin-2 (5-HT2) receptors, suggest that changes in serotonergic neurotransmission may be relevant to the enhanced efficacy of the combination of tricyclic antidepressants and neuroleptics, compared to either type of drug alone, in the treatment of delusional depression.