Relative Effectiveness of Monoamine Oxidase Inhibitor and Tricyclic Antidepressant Combination Therapy for Treatment-Resistant Depression

Autor: Thomas T Kim, Jay D. Amsterdam
Rok vydání: 2019
Předmět:
inorganic chemicals
Adult
Male
endocrine system
medicine.medical_specialty
Monoamine Oxidase Inhibitors
Combination therapy
Adolescent
medicine.drug_class
Tricyclic antidepressant
Antidepressive Agents
Tricyclic
Gastroenterology
03 medical and health sciences
Depressive Disorder
Treatment-Resistant
Young Adult
0302 clinical medicine
Pharmacotherapy
Internal medicine
Outcome Assessment
Health Care
medicine
Humans
Pharmacology (medical)
Adverse effect
Retrospective Studies
Monoamine oxidase inhibitor
business.industry
digestive
oral
and skin physiology
Retrospective cohort study
Middle Aged
medicine.disease
030227 psychiatry
Psychiatry and Mental health
Mood disorders
Practice Guidelines as Topic
Drug Therapy
Combination
Female
business
Treatment-resistant depression
030217 neurology & neurosurgery
Zdroj: Journal of clinical psychopharmacology. 39(6)
ISSN: 1533-712X
Popis: Purpose/background We examined the relative safety and effectiveness of adding a monoamine oxidase inhibitor (MAOI) to a failed tricyclic antidepressant (TCA) trial versus adding a TCA to a failed MAOI trial or adding a TCA to a failed TCA trial in treatment-resistant depression. Methods/procedures Data were retrospectively harvested from approximately 2500 treatment charts of subjects with treatment-resistant depression who attended a university mood disorders clinic between 1983 and 2015. Hierarchical linear modeling was used to examine the effectiveness of treatment condition on outcome. Relative adverse event profiles were also examined. Findings/results Eighty-four treatment outcome observations were made from 54 subjects who received combination therapy: TCA plus TCA (n = 22), TCA plus MAOI (n = 44), and MAOI plus TCA (n = 18). Treatment condition predicted a poorer (albeit not statistically significant) outcome for TCA plus TCA compared with TCA plus MAOI, or MAOI plus TCA therapy (P = 0.098). Specific adverse events occurred with significantly greater frequency between treatment groups; that is, impotence was more frequent with TCA plus MAOI therapy; headaches and insomnia were more frequent with MAOI plus TCA therapy; and constipation was more frequent with TCA plus TCA therapy. There were no reported or observed hypertensive or serotonergic events. Implications/conclusions In contrast to conventional wisdom that combined TCA and MAOI therapy should be avoided, the judicious use of this combination may be relatively safe and effective compared with combined TCA plus TCA therapy. However, sample sizes were limited, and the analysis was nonrandomized and retrospective.
Databáze: OpenAIRE
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