Bromocriptine and imipramine in endogenous depression. A double-blind controlled trial in out-patients.

Among 33 out-patients with endogenous depression, 16 were treated with bromocriptine (10-60 mg/day, mean 34) and 17 with imipramine (75-250 mg/day, mean 143). The total score on the Hamilton Rating Scale decreased during 6-week treatment from 19.9 to 7.8 in the bromocriptine group (P less than 0.001) and from 20.1 to 6.1 in the imipramine group (P less than 0.001). There was no significant difference between the two groups. The main side-effects were for bromocriptine: nausea, dizziness, and headache; for imipramine; dryness of mouth, dizziness, and sweating. This study suggests an antidepressant effect of bromocriptine although, due to the possibility of Type II error, it may not necessarily be equal to that of imipramine.

Antidepressant drugs in anergic schizophrenia. A double-blind cross-over study with maprotiline and placebo.

Seventeen out of 20 inactive and emotionally withdrawn schizophrenic patients under long-term neuroleptic treatment completed a double-blind cross-over investigation of the possible activating effect of maprotiline, a relatively specific noradrenaline-reuptake inhibitor, compared with that of placebo. Each treatment phase lasted 8 weeks. No significant differences with respect to either the level of activity or schizophrenic symptoms were found between maprotiline (mean dose 138 mg/day) and placebo. Maprotiline provoked a slight psychotic exacerbation in one patient and sedation in another, four patients developed orthostatic hypotension, and two patients had an epileptic seizure. In the light of this and other studies, it must be concluded that antidepressant drugs do not represent any therapeutic advance in the treatment of inactive schizophrenic patients receiving neuroleptics.

Perphenazine decanoate vs. perphenazine enanthate: efficacy and side effects in a 6 week double-blind, comparative study of 50 drug monitored psychotic patients.

In a six-week randomized, double-blind study the efficacy and side effects of perphenazine decanoate (PD) and perphenazine enanthate (PE) were evaluated and compared in 26 and 24 acute psychotic patients respectively. Of either formulation 100 mg were administered intramuscularly every two weeks. Maximum and minimum plasma concentrations of perphenazine were measured for each injection period using gas liquid chromatography. There was no statistically significant difference between PD and PE in terms of overall antipsychotic efficacy, assessed by means of the Brief Psychiatric Rating Scale (BPRS). However, when an 'Amelioration Score' (AMS) of at least 50% of the totally obtainable scores was defined as individual response criterion it was revealed that the PD group only one patient (4%) did not meet this criterion, compared with six patients (25%) in the PE group. Extrapyramidal side effects were significantly more pronounced in the PE-treated patients, who also required significantly higher amounts of antiparkinson medication. The mean maximum concentration of perphenazine in plasma was 5.0 nmol/l in the PD, and 10.6 nmol/l in the PE-treated patients. The ratio of the mean maximum to the mean minimum concentration was 1.41 and 4.02 in the decanoate and enanthate groups respectively. In the patients treated with PD there were signs of accumulation indicating the possibility of prolonging dosage intervals. The present study yielded further support to previous findings demonstrating that intramuscular administration of PD dissolved in sesame oil, in contrast to PE, results in even and flat plasma perphenazine concentration curves, which not only provides a stable antipsychotic effect but also most likely carry the responsibility for the low incidence of extrapyramidal side effects observed.