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Clomipramine augmentation in treatment-resistant depression
J D Amsterdam1, F García-España, M Rosenzweig
1Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
Depression and Anxiety
|January 1, 1997
Summary
Augmenting treatment-resistant depression with clomipramine showed marginal benefits and significant adverse events, especially when combined with monoamine oxidase inhibitors. Caution is advised for this combination therapy.
Area of Science:
- Pharmacology
- Psychiatry
- Clinical Medicine
Background:
- Treatment-resistant depression (TRD) often requires combination antidepressant therapy.
- Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are alternatives to tricyclic antidepressants (TCAs).
- Combining different antidepressant classes may enhance efficacy in TRD.
Purpose of the Study:
- To evaluate the efficacy of clomipramine augmentation in patients with TRD.
- To compare clomipramine augmentation with MAOI/TCA combination therapy.
- To assess the safety and adverse events associated with clomipramine augmentation.
Main Methods:
- 20 patients with treatment-resistant depression were studied.
- Groups included MAOI/clomipramine, fluoxetine/clomipramine, and MAOI/TCA.
- Efficacy and adverse events were compared between groups.
Main Results:
- Clomipramine augmentation showed marginal efficacy compared to MAOI/TCA.
- MAOI/clomipramine group had significantly more adverse events (56%), including serotonin syndrome.
- Fluoxetine/clomipramine (9%) and MAOI/TCA (0%) groups had fewer adverse events.
Conclusions:
- Clomipramine augmentation of failed MAOI therapy has limited efficacy.
- This combination therapy should be used with extreme caution due to adverse events.
- MAOI/TCA combination may be a safer alternative for TRD.