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The Importance of Dosage in Prescribing Antidepressants

Published online by Cambridge University Press:  29 January 2018

Frederick M. Quitkin
Frederick M. Quitkin*
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University; and New York Psychiatric Institute, 722 West 168th Street, New York, New York 10032, USA
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Extract

The treatment of depressive disorders was significantly altered by the introduction of the tricyclic antidepressants and the monoamine oxidase inhibitors. One salient factor in determining efficacy is the dose prescribed. The few good dose response studies which are available indicate that patients should receive 300 mg of imipramine or equivalent, and a separate trial of 90 mg of phenelzine or equivalent, before concluding they are treatment refractory. Data are reviewed which suggest many patients receive inadequate doses.

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The British Journal of Psychiatry , Volume 147 , Issue 6 , December 1985 , pp. 593 - 597
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Copyright © 1985 The Royal College of Psychiatrists 

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References

Åsberg, M., Cronholm, G., Sjoqvist, F. & Tuck, D. (1971) Relationship between plasma level and therapeutic effect of nortriptyline. British Medical Journal, 3, 331–334.Google Scholar
Braithwaite, F. A., Goulding, R., Theano, B., Bailly, J. & Coppen, A. (1972) Plasma concentrations of amitriptyline and clinical response. Lancet, i, 1297–1300.Google Scholar
Bridges, P. K. (1983) Point of view. British Journal of Psychiatry, 142, 676–687.Google Scholar
Brogden, R. N., Hell, R. D. & Speight, T. (1981) Trazodone: A review of its pharmacological properties and therapeutic uses in depression and anxiety. Drugs, 21, 401–420.CrossRefGoogle Scholar
Burrows, G., Davies, G. & Scoggins, B. (1972) Plasma concentration of nortriptyline and clinical response in depressive illness. Lancet, 2, 619–623.Google Scholar
Burrows, G., Scoggins, B., Tuereck, L. & Davies, B. (1974) Plasma nortriptyline and clinical response. Clinical Pharmacology and Therapeutics, 16, 639–644.CrossRefGoogle ScholarPubMed
Coppen, A., Ghose, K., Montgomery, S., Rama-Rod, V. A., Bailey, J., Christiansen, J., Mikkleson, P. L., Vanpraag, H. M., Vandepoel, F., Minsker, E. J., Kozulja, V. G., Matussek, N., Kungkunz, G. & Jorgensen, A. (1978) Amitriptyline plasma concentrations and clinical effect: A World Health Organization Collaborative Study. Lancet, i, 63–66.Google Scholar
Devane, C. L., Wolin, R. E., Rovere, R. A., et al (1981) Excessive plasma concentrations of tricyclic antidepressants resulting from usual doses. Journal of Clinical Psychiatry, 42, 143–147.Google ScholarPubMed
Fauman, M. A., (1980) Tricyclic antidepressant prescription by general hospital physicians. American Journal of Psychiatry, 137, 490–491.Google Scholar
Friedel, R. O., Veith, R. O., Bloom, U. & Bielski, R. (1979) Desipramine plasma levels and clinical response in depressed outpatients. Community Psychopharmacology, 3, 81–87.Google Scholar
Glassman, A., Perel, J., Shostak, , Kantor, S., Fleiss, J. (1977) Clinical implications of imipramine plasma levels for depressive illness. Archives of General Psychiatry, 34, 197–204.Google Scholar
Gram, L., Reisby, M., Ibsen, I., et al (1976) Plasma levels in antidepressant effects of imipramine. Clinical Pharmacology and Therapeutics, 19, 318–324.CrossRefGoogle ScholarPubMed
Guze, S. B. & Robbins, E. (1970) Suicide and primary affective disorder. British Journal of Psychiatry, 117, 437–438.CrossRefGoogle Scholar
Hollister, L. (1979) Monitoring tricyclic antidepressant plasma concentrations. Journal of the American Medical Association, 241, 2530–2533.Google Scholar
Jandhyala, B. S., Steinberg, M. L., Perel, J. M., et al (1977) Effects of several tricyclic antidepressants, and the hemodynamics and myocardial contractibilily of anesthetized dogs. European Journal of Pharmacology, 42, 409–410.CrossRefGoogle ScholarPubMed
Johnson, D. A. W. (1974) A study of the use of antidepressant medication in general practice. British Journal of Psychiatry, 125, 186–192.CrossRefGoogle ScholarPubMed
Jue, S. G., Dawson, G. W. & Brogden, R. N. (1982) Amoxapine: A review of its pharmacology and efficacy in depressed states. Drugs, 24, 1–23.Google Scholar
Keller, M. C., Klerman, G. L., Lavori, P. W., Fawceti, J. A., Coryell, W. & Endicoit, J. (1982) Treatment received by depressed patients. Journal of the American Medical Association, 248, 1848–1855.Google Scholar
Ketai, R. (1976) Family practitioners knowledge about treatment of depressive illness. Journal of the American Medical Association, 235, 2600–2603.Google Scholar
Klein, D. F. & Davis, J. M. (1969) Diagnosis and Drug Treatment of Psychiatric Disorders. Baltimore: Williams & Wilkins.Google Scholar
Kotin, J., Post, R. M. & Goodwin, F. K., (1973) Drug treatment of depressed patients referred for hospitalization. American Journal of Psychiatry, 130, 1139–1141.Google Scholar
Kragh-Sorenson, P., Hansen, C., Baastrup, T., et al (1976) Self inhibiting action of nortriptyline to antidepressant effects at high plasma levels. Psychopharmacology, 45, 305–312.Google Scholar
Kupfer, D., Hanin, I., Spiker, D., Grau, T. & Coble, P. (1977) Amitriptyline plasma levels and clinical response in primary depression. Clinical Pharmacology and Therapeutics, 22, 904–911.Google Scholar
Nelson, J. C., Jatlow, P., Quinlan, D. M. & Bowers, M. B. (1982a) Desipramine plasma concentration and antidepressant response. Archives of General Psychiatry, 39, 1419–1422.Google Scholar
Nelson, J. C., Jatlow, P., Bock, J., et al (1982b) Major adverse reactions during desipramine treatment. Archives of General Psychiatry, 39, 1055–1061.CrossRefGoogle ScholarPubMed
Pare, C. M. B. (1985) The present status of monoamine oxidase inhibitors. British Journal of Psychiatry, 146, 576–584.CrossRefGoogle ScholarPubMed
Perel, J. M. (1983) Tricyclic antidepressant plasma levels, pharmacokinetics and clinical outcome. In Psychiatry Update, American Association Annual Review, 2, 491–511. Washington, D. C., American Psychiatric Press.Google Scholar
Pinder, R. M., Brogden, R. N., Speight, T., et al (1977) Maprotiline: A review of its pharmacological properties and therapeutic efficacy in mental depressive states. Drugs, 13, 321–352.Google Scholar
Ravaris, C. L., Nies, A., Robinson, D., et al (1976) A multiple dose controlled study of phenelzine in depression-anxiety states. Archives of General Psychiatry, 33, 347–350.CrossRefGoogle ScholarPubMed
Reisby, M., Gram, L. & Bech, P. (1977) Imipramine: Clinical effects and pharmocokinetic variability. Psychopharmacology, 54, 263–272.Google Scholar
Remick, R. A., Barton, J. S. & Patterson, B. (1983) On so-called treatment resistant depression. Presented at 51st Annual Meeting, Royal College of Physicians & Surgeons of Canada, Quebec City, Sept. 1982. In International Drug Therapy Newsletter, 18, No. 7. (ed. Ayd, F. J.).Google Scholar
Robinson, D. S., Copper, T. B., Ravaris, C. L., et al (1979) Plasma tricyclic drug levels in amitriptyline-treated depressed patients. Psychopharmacology, 63, 223–231.CrossRefGoogle ScholarPubMed
Roose, S. D., Glassman, H. & Siris, S. (1981) Comparison of imipramine and nortriptyline induced orthostatic hypotension: A meaningful difference. Journal of Clinical Psychopharmacology, 1, 316–319.Google Scholar
Schatzberg, A. F., Çole, J. O., Cohen, B. M., et al (1983) Survey of depressed patients who failed to respond to treatment. In The Affective Disorders (ed. Davis, J. M. & Maas, J. W.). Washington, D.C.: American Psychiatric Press.Google Scholar
Schuckit, N. A. & Feighner, J. D. (1972) Safety of high dose tricyclic antidepressant therapy. American Journal of Psychiatry, 128, 1456–1459.CrossRefGoogle ScholarPubMed
Simpson, G. M., Lee, J. H., Cuculica, A. & Kellner, R. (1976) Two dosages of imipramine in hospitalised endogenous and neurotic depressives. Archives of General Psychiatry, 33, 1093–1102.CrossRefGoogle ScholarPubMed
Simpson, G. M., White, K. L., Boyd, J. L., et al (1982) Relationship between plasma antidepressant levels and clinical outcome from inpatients receiving imipramine. American Journal of Psychiatry, 139, 358–366.Google ScholarPubMed
Sjoqvist, F., Bertilsoon, L. & Asberg, M. (1980) Monitoring tricyclic antidepressants. Therapeutic Drug Monitoring, 2, 85–93.Google Scholar
Tsuang, M. T. (1978) Suicide in schizophrenics, manic depressives and surgical controls. Archives of General Psychiatry, 35, 153–155.CrossRefGoogle ScholarPubMed
Tyrer, P., Gardner, M., Lambourn, J. & Whitford, M. (1980) Clinical and pharmacokinetic factors affecting response to phenelzine. British Journal of Psychiatry, 136, 359–365.Google Scholar
Walter, C B. (1971) Drug plasma levels and clinical effect. Proceedings of the Royal Society of Medicine, 64, 281–285.Google Scholar
Watt, D. C., Crammer, J. L. & Elkes, A. (1972) Metabolism, anticholinergic effects and therapeutic effects on outcome of desmethylimipramine in depressive illness. Psychological Medicine, 2, 397–405.CrossRefGoogle ScholarPubMed
Whyte, S. F., Macdonald, A., Naylor, G. & Moody, J. (1976) Plasma concentrations of protriptyline and clinical effects in depressed women. British Journal of Psychiatry, 128, 384–390.Google Scholar
Ziegler, V., Co, B. T., Taylor, J., Clayton, P. & Biggs, J. (1976a) Amitriptyline plasma levels and therapeutic response. Clinical Pharmacology and Therapeutics, 19, 795–801.Google Scholar
Ziegler, V., Clayton, P., Taylor, J., Co, B. T. & Biggs, J. (1976b) Nortriptyline plasma levels in therapeutic response. Clinical Pharmacology and Therapeutics, 20, 458–463.CrossRefGoogle ScholarPubMed
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