A double-blind trial comparing mianserin and maprotiline in depressed inpatients

The antidepressant effects and side effects of mianserin and maprotiline were assessed in a double-blind trial in 62 inpatients (34 men and 28 women; mean age, 43.6 years) with primary depressive illness. For the first week of the trial, 32 patients received 30 mg/day of mianserin and 30 patients received 75 mg/day of maprotiline; for the next three weeks, the dosage of each drug was doubled. According to scores on the Hamilton Psychiatric Rating Scale for Depression, administered on days 0, 7, 14, 21, and 28, the antidepressant effects of the two drugs were virtually identical. Results of electrocardiographic and vectorcardiographic recordings and other measurements indicated that by day 28 the QRS duration was significantly longer (P less than 0.05) in the maprotiline group. On days 14 and 28, mean systolic blood pressure was significantly higher (P less than 0.05) in the maprotiline group. By day 28, the incidence of anticholinergic side effects--constipation and dry mouth--was significantly higher (P less than 0.05) in the maprotiline group. Although maprotiline's effects on heart functions never reached clinical significance, its anticholinergic side effects could be bothersome, especially to older patients.