Combined Treatment With Venlafaxine and Tricyclic Antidepressants in Depressed Patients Who Had Partial Response to Clomipramine or Imipramine: Initial Findings
J Clin Psychiatry 2000;61(4):285-289
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: We report, after 3 years of
work, a case series showing our initial results (efficacy,
tolerability, and safety) with the addition of venlafaxine
immediate release (IR) to either clomipramine or imipramine in
depressed patients who had shown only partial response to maximal
doses of one of those tricyclic antidepressants (TCAs) and no
further improvement after addition of usual augmentation drugs.
Method: Eleven patients were treated, 10 of them
having a recurrent depressive disorder (DSM-IV) and all of them
having current major depression (DSM-IV) that in 9 patients was
moderate or severe despite intense TCA treatment as well as usual
augmentations. Under open and outpatient conditions, we
maintained TCA doses, discontinued previous augmentations, and
then added venlafaxine IR to a maximum dosage, if necessary, of
150 mg every 12 hours. There was no control group. Response was
assessed using the 17-item Hamilton Rating Scale for Depression
(HAM-D), DSM-IV criteria, the Clinical Global
Impressions-Severity of Illness scale, and persistence of
improvements after 6 months. We measured clinical tolerance
(using the UKU Side Effect Rating Scale), blood pressure and
heart rate, electrocardiogram (ECG), and blood TCA levels after
adding venlafaxine IR.
Results: A sustained improvement (> 50%
decrease in HAM-D score plus decrease in DSM-IV severity level)
appeared in 9 patients, and sustained full remission (DSM-IV
criteria plus HAM-D score < 5) in 7. Panic-agoraphobic
symptoms improved in the 2 patients suffering from them. There
were no dropouts, and tolerability was good. No significant
changes in blood pressure and heart rate, ECG, or blood tricyclic
levels were found.
Conclusion: Addition of venlafaxine to
clomipramine or imipramine could be an effective and safe
augmentation strategy in depressive patients with partial
response to maximum-dose monotherapy. A consistent replication of
these initial findings is strongly needed.