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Long-term amitriptyline in chronic depression.

E Giller, D Bialos, L Harkness

    The Hillside Journal of Clinical Psychiatry
    |January 1, 1985
    PubMed
    Summary
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    Discontinuing long-term antidepressant medication, like amitriptyline (AMI), often leads to depressive recurrence in patients. Most patients experienced withdrawal reactions or depression upon stopping AMI, highlighting the need for careful management.

    Area of Science:

    • Psychiatry and Clinical Pharmacology
    • Neuroscience of Mood Disorders

    Background:

    • Chronic depression management often involves long-term antidepressant therapy.
    • The efficacy and safety of sustained amitriptyline (AMI) use require ongoing investigation.
    • Understanding antidepressant discontinuation effects is crucial for patient care.

    Purpose of the Study:

    • To evaluate the recurrence of depression after discontinuing long-term amitriptyline (AMI) treatment.
    • To differentiate between depressive recurrence and withdrawal symptoms upon AMI cessation.
    • To assess tolerance to anticholinergic side-effects during prolonged AMI therapy.

    Main Methods:

    • A six-month, placebo-controlled, double-blind protocol was employed.
    • 17 patients with chronic depression on long-term AMI (average 3.7 years, 138 mg/day) underwent medication discontinuation.

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  • Patients were monitored for depressive recurrence and withdrawal reactions.

    • Main Results:

    • 11 out of 15 patients (73%) receiving placebo experienced depressive recurrence within 9.3 weeks.
    • Only 1 out of 9 patients (11%) on active medication relapsed.
    • 12 out of 15 patients (80%) on placebo showed distinct withdrawal reactions during AMI tapering.

    Conclusions:

    • Long-term antidepressant treatment with amitriptyline (AMI) is associated with a high rate of depressive recurrence upon discontinuation.
    • Withdrawal reactions are common and distinguishable from depressive relapse.
    • Tolerance to anticholinergic side-effects did not develop with sustained AMI use.