Phenelzine and Dexamphetamine in Depressive Illness
Authors: E. H. Hare, J. Dominian, L. Sharpe
Journal: BMJ (1962)

~~~~~~~~~~~~~~~~~~~~MIEDICAL JOURNAL9affective disorders.We have found, for instance, that those patients with anxiety states or depressions most likely to respond to M.A.O.I., or to M.A.O.I. combined with chlordiazepoxide, do generally have certain characteristics in common.Early-morning waking may be present, but more often there is an inability to get to sleep, or there may even be an increased depth of sleep.Many patients also tend to get worse as the day goes on rather than better, which is very different from the constant early-morning waking and diurnal mood- swing of the true endogenous depression.Severe fatigue is a common complaint, and there is a great variation in the patient's symptoms and in his emotionality from day to day.Patients also tend to blame others rather than themselves, and premenstrual tension and irritability are very commonly found in the symptomatology of women who are going to make a good response to the M.A.O.I. drugs.After four years' experience of a wide range of antidepressant drugs, we have found M.A.O.I. to act best in these anxiety and atypical depressive states, rather than in the more typical endogenous depressive illnesses, which generally do better with imipramine combined with electric convulsion treatment.In fact, it seems that if an anxiety state or an " atypical " depression, particularly of recent origin and occurring in a patient of good previous personality, does not respond within 10 days to one or other of the M.A.O.I. drugs and chlordiazepoxide, correctly given, both the diagnosis and the treatment should be reconsidered.Then, especially in the middle-aged, it will often be found that anxiety symptoms are masking a deep underlying depression needing additional or other treatment. SummaryTwo years ago iproniazid was reported as being valuable in the treatment of "atypical" depressions.Subsequent experience with iproniazid and the newer monoamine oxidase inhibitors (M.A.O.I.) has shown that there is no clear treatment demarcation between some atypical depressions and anxiety states; and many anxiety states have now, in fact, been found to respond equally well to treatment with the M.A.O.I., preferably combined with chlordiazepoxide hydrochloride.To illustrate these points, the effect of these drugs on 60 out-patients with a diagnosis of atypical depression, anxiety hysteria, or anxiety neurosis is reported.They fall into three groups: 15 patients responded to M.A.O.I. alone, 28 did best with M.A.O.I. combined with chlordiazepoxide, and 17 did not respond to M.A.O.I.Chlordiazepoxide given alone to these patients was much less effective, except in the last group.These findings are discussed, and stress is laid on the proper use of M.A.O.I. drugs to avoid undesirable side-effects and relapse.The essential factor for success with M.A.O.I. and chlordiazepoxide in the treatment of anxiety states is a good previous personality.*Basic N.H.S. prices in May, 1961, were: " tofranil " (imipramine), 25-mg.tablets, 1,000 for 275s.; " nardil" (phenelzine), lS-mg.tablets, 50 for 97s.-lOd.plus 24s.3d.purchase tax; dexamphetamine sulphate, 5-mg.tablets, 1,000 for 6s.