Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-25T10:07:27.844Z Has data issue: false hasContentIssue false
  • English
  • Français

Is trazodone more effective than clomipramine in major depressed outpatients? A single-blind study with intravenous and oral administration

Published online by Cambridge University Press:  30 October 2017

Massimiliano Buoli ,
Chiara Rovera ,
Sara Maria Pozzoli ,
Alessio Fiorentini ,
Laura Cremaschi ,
Alice Caldiroli Open the ORCID record for Alice Caldiroli [Opens in a new window]  and
A. Carlo Altamura
Massimiliano Buoli
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
Chiara Rovera
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
Sara Maria Pozzoli
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
Alessio Fiorentini
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
Laura Cremaschi
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
Alice Caldiroli*
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
A. Carlo Altamura
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
*
*Address for correspondence: Alice Caldiroli, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Some antidepressants, such as trazodone or clomipramine, can be administered intravenously in patients with major depressive disorder (MDD), with potential benefits compared to the standard oral treatment, but available data about their efficacy are limited. The present study was aimed to compare the effectiveness of trazodone and clomipramine (intravenous [i.v.] followed by oral administration).

Methods

Some 42 patients with a diagnosis of MDD according to the DSM–5 were selected and treated with i.v. trazodone or clomipramine according to clinical judgment. The Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Montgomery-Åsberg Depression Rating Scale were administered at baseline, after 2 weeks, and after 6 weeks, as well as after 1 week of intravenous antidepressant administration. Raters were blinded to type of treatment.

Results

No significant differences were found between treatment groups in terms of effectiveness at endpoint. Borderline statistical significance was found in terms of number of responders in favor of trazodone. In addition, patients treated with trazodone reported fewer total side effects than those treated with clomipramine.

Conclusion

Both i.v. trazodone and clomipramine are rapid and effective options for improving depressive symptoms, although trazodone appears to be tolerated better. Further studies with larger samples and double-blind conditions are warranted to confirm our results.

Keywords

Antidepressantdepressionanxiety/anxiety disordersclinical trialsmood disorderspharmacotherapy
Type
Original Research
Information
CNS Spectrums , Volume 24 , Issue 2 , April 2019 , pp. 258 - 264
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Wittchen, HU, Jacobi, F. Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005; 15(4): 357–376.CrossRefGoogle ScholarPubMed
Kirino, E, Gitoh, M. Rapid improvement of depressive symptoms in suicide attempters following treatment with milnacipran and tricyclic antidepressants: a case series. Neuropsychiatr Dis Treat. 2011; 7: 723–728.Google ScholarPubMed
Bauer, M, Pfennig, A, Severus, E, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry. 2013; 14(5): 334–385.CrossRefGoogle ScholarPubMed
Altamura, AC, Buoli, M, Serati, M. Duration of illness and duration of untreated illness in relation to drug response in psychiatric disorders. Neuropsychiatry. 2011; 1: 81–90.CrossRefGoogle Scholar
Buoli, M, Cumerlato Melter, C, Caldiroli, A, Altamura, AC. Are antidepressants equally effective in the long-term treatment of major depressive disorder? Hum Psychopharmacol. 2015; 30(1): 21–27.CrossRefGoogle ScholarPubMed
Chang, T, Fava, M. The future of psychopharmacology of depression. J Clin Psychiatry. 2010; 71(8): 971–975.CrossRefGoogle Scholar
Machado, M, Iskedjian, M, Ruiz, I, Einarson, TR. Remissions, dropouts, and adverse drugs reactions rates in major depressive disorder: a meta-analysis of head-to-head trials. Curr Med Res Opin. 2006; 22(9): 1825–1837.CrossRefGoogle Scholar
Buoli, M, Dell’Osso, B, Bosi, MF, Altamura, AC. Slow vs. standard up-titration of paroxetine in the treatment of panic disorder: a prospective randomized trial. Psychiatry Clin Neurosci. 2010; 64(6): 612–619.CrossRefGoogle ScholarPubMed
Dell’Osso, B, Buoli, M, Baldwin, DS, Altamura, AC. Serotonin norepinephrine reuptake inhibitors (SNRIs) in anxiety disorders: a comprehensive review of their clinical efficacy. Hum Psychopharmacol. 2010; 25(1): 17–29.CrossRefGoogle ScholarPubMed
Fava, M. Daytime sleepiness and insomnia as correlates of depression. J Clin Psychiatry. 2004; 65(Suppl 16): 27–32.Google Scholar
Fava, M, Hoog, SL, Judge, RA, Kopp, JB, Nilsson, ME, Gonzales, JS. Acute efficacy of fluoxetine versus sertraline and paroxetine in major depressive disorder including effects of baseline insomnia. J Clin Psychopharmacol. 2002; 22(2): 137–147.CrossRefGoogle ScholarPubMed
Altamura, AC, Dell’Osso, B, Buoli, M, Zanoni, S, Mundo, E. Intravenous augmentative citalopram versus clomipramine in partial/nonresponder depressed patients: a short-term, low dose, randomized, placebo-controlled study. J Clin Psychopharmacol. 2008; 28(4): 406–410.CrossRefGoogle ScholarPubMed
Altamura, AC, Dell’Osso, B, Buoli, M, Bosi, M, Mundo, E. Short-term intravenous citalopram augmentation in partial/nonresponders with major depression: a randomized placebo-controlled study. Int Clin Psychopharmacol. 2008; 23(4): 198–202.CrossRefGoogle ScholarPubMed
Gastpar, M, Ngo Khac, T, Gilsdorf, U, Baumann, P. Comparison of oral and intravenous treatment of depressive states: preliminary results of a WHO collaborative study. Clin Neuropharmacol. 1986; 9(Suppl 4): 434–436.Google ScholarPubMed
Bareggi, SR, Cavallaro, R, Pirola, R, Altamura, AC. Pharmacokinetics and adverse effects of single doses of dothiepin in young and elderly subjects. Prog Neuropsychopharmacol Biol Psychiatry. 1990; 14(2): 163–170.CrossRefGoogle Scholar
Guelfi, JD, Strub, N, Loft, H. Efficacy of intravenous citalopram compared with oral citalopram for severe depression. Safety and efficacy data from a double-blind, double-dummy trial. J Affect Disord. 2000; 58(3): 201–209.CrossRefGoogle ScholarPubMed
Moukaddam, NJ, Hirschfeld, RM. Intravenous antidepressants: a review. Depress Anxiety. 2004; 19(1): 1–9.CrossRefGoogle ScholarPubMed
Kelly, MW, Myers, CW. Clomipramine: a tricyclic antidepressant effective in obsessive compulsive disorder. DICP. 1990; 24(7–8): 739–744.CrossRefGoogle ScholarPubMed
Luscombe, DK, Wright, J, Jain, VK. Plasma level studies of clomipramine and desmethylclomipramine following intravenous infusions of clomipramine in depressive patients. Postgrad Med J. 1977; 53(Suppl 4): 88–96.Google ScholarPubMed
Dudley, DL, Volberding, N, Loebel, P. Intravenous chlorimipramine and refractory depression. Gen Hosp Psychiatry. 1980; 2(1): 61–64.CrossRefGoogle ScholarPubMed
Pollock, BG, Perel, JM, Nathan, RS, Kupfer, DJ. Acute antidepressant effect following pulse loading with intravenous and oral clomipramine. Arch Gen Psychiatry. 1989; 46(1): 29–35.CrossRefGoogle ScholarPubMed
Sallee, FR, Pollock, BG, Perel, JM, Ryan, ND, Stiller, RL. Intravenous pulse loading of clomipramine in adolescents with depression. Psychopharmacol Bull. 1989; 25(1): 114–118.Google ScholarPubMed
Sallee, FR, Vrindavanam, NS, Deas-Nesmith, D, Carson, SW, Sethuraman, G. Pulse intravenous clomipramine for depressed adolescents: double-blind, controlled trial. Am J Psychiatry. 1997; 154(5): 668–673.Google ScholarPubMed
Stahl, SM. Mechanism of action of trazodone: a multifunctional drug. CNS Spectr. 2009; 14(10): 536–546.CrossRefGoogle ScholarPubMed
Khouzam, HR. A review of trazodone use in psychiatric and medical conditions. Postgrad Med. 2017; 129(1): 140–148.CrossRefGoogle ScholarPubMed
Fagiolini, A, Comandini, A, Catena Dell’Osso, M, Kasper, S. Rediscovering trazodone for the treatment of major depressive disorder. CNS Drugs. 2012; 26(12): 1033–1049.CrossRefGoogle ScholarPubMed
Savarese, M, Carnicelli, M, Cardinali, V, Mogavero, MP, Federico, F. Subjective hypnotic efficacy of trazodone and mirtazapine in patients with chronic insomnia: a retrospective, comparative study. Arch Ital Biol. 2015; 153(2–3): 231–238.Google ScholarPubMed
Goracci, A, Forgione, RN, De Giorgi, R, Coluccia, A, Cuomo, A, Fagiolini, A. Practical guidance for prescribing trazodone extended-release in major depression. Expert Opin Pharmacother. 2016; 17(3): 433–441.CrossRefGoogle ScholarPubMed
Gerner, R, Estabrook, W, Steuer, J, Jarvik, L. Treatment of geriatric depression with trazodone, imipramine, and placebo: a double-blind study. J Clin Psychiatry. 1980; 41(6): 216–220.Google ScholarPubMed
Altamura, AC, Mauri, MC, Colacurcio, F, et al. Trazodone in late life depressive states: a double-blind multicenter study versus amitriptyline and mianserin. Psychopharmacology (Berl). 1988; 95(Suppl): 34–36.CrossRefGoogle ScholarPubMed
Altamura, AC, Mauri, MC, Rudas, N, et al. Clinical activity and tolerability of trazodone, mianserin, and amitriptyline in elderly subjects with major depression: a controlled multicenter trial. Clin Neuropharmacol. 1989; 12(Suppl 1): 25–33.CrossRefGoogle ScholarPubMed
Monteleone, P, Gnocchi, G. Evidence for a linear relationship between plasma trazodone levels and clinical response in depression in the elderly. Clin Neuropharmacol. 1990; 13(Suppl 1): 84989.CrossRefGoogle ScholarPubMed
Altamura, AC, Mauri, MC, Moro, AR. Fluvoxamine: a novel 5-hydroxytryptamine uptake inhibitor: present and future clinical application. In. Headache and Depression: Serotonin Pathways as a Common Clue. New York: Raven Press; 1991.Google Scholar
Schroeck, JL, Ford, J, Conway, EL, et al. Review of safety and efficacy of sleep medicines in older adults. Clin Ther. 2016; 38(11): 2340–2372.CrossRefGoogle ScholarPubMed
Roccatagliata, G, Abbruzzese, G, Albano, C, Cocito, L, Gandolfo, C. Trazodone by intravenous infusion in depressions secondary to organic disease. Int Pharmacopsychiatry. 1977; 12(2): 72–79.CrossRefGoogle ScholarPubMed
Berzewski, H. Clinical experience with antidepressive infusion therapy: trazodone. Psychopharmacology (Berl). 1988; 95(Suppl): 31–33.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. [DSM–5]. Arlington, VA: American Psychiatric Press; 2013.Google Scholar
Wijeratne, C, Sachdev, P. Treatment-resistant depression: critique of current approaches. Aust N Z J Psychiatry. 2008; 42(9): 751–762.CrossRefGoogle ScholarPubMed
Fagiolini, A, Amodeo, G, Goracci, A, Blardi, P. Trazodone Contramid® in clinical practice: personalizing antidepressant intervention [in Italian]. Riv Psichiatr. 2016; 51(4): 123–128.Google Scholar
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 56.CrossRefGoogle Scholar
Montgomery, SA, Åsberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134: 382–389.CrossRefGoogle ScholarPubMed
Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32(1): 50.CrossRefGoogle ScholarPubMed
Amsterdam, JD, Horning, M, Nierenberg, AA. Treatment-Resistant Mood Disorders. Cambridge: Cambridge University Press; 2001.CrossRefGoogle Scholar
Flight, L, Julious, SA. Practical guide to sample size calculations: an introduction. Pharm Stat. 2016; 15(1): 68–74.CrossRefGoogle Scholar
Nil, R, Lütolf, S, Seifritz, E. Residual symptoms and functionality in depressed outpatients: a one-year observational study in Switzerland with escitalopram. J Affect Disord. 2016; 197: 245–250.CrossRefGoogle ScholarPubMed
Greenspan, D. Xerostomia: diagnosis and management. Oncology (Williston Park). 1996; 10(3 Suppl): 7–11.Google ScholarPubMed
Núñez, R, Perel, JM. Comparative neurotransmitter reuptake and anticholinergic potencies of the 8-hydroxy metabolites of clomipramine. Psychopharmacol Bull. 1995; 31(2): 217–221.Google ScholarPubMed
Kasper, S, Müller-Spahn, F. Intravenous antidepressant treatment: focus on citalopram. Eur Arch Psychiatry Clin Neurosci. 2002; 252(3): 105–109.CrossRefGoogle ScholarPubMed
Bouchard, JM, Strub, N, Nil, R. Citalopram and viloxazine in the treatment of depression by means of slow drop infusion: a double-blind comparative trial. J Affect Disord. 1997; 46(1): 51958.CrossRefGoogle ScholarPubMed
Hosaka, T, Aoki, T, Watanabe, T, Okuyama, T, Kurosawa, H. General hospital psychiatry from the perspective of medical economics. Psychiatry Clin Neurosci. 1999; 53(4): 449–453.CrossRefGoogle ScholarPubMed