The presence of mixed symptoms of anxiety and depression are well known to every clinician. Panic, generalised anxiety and obsessive-compulsive disorder all have considerable overlap with major depressive illness. Factor analysis of anxiety and depression symptoms has sought to predict response to treatment as well as to establish a diagnosis. Sleep disturbances are important concomitants of both syndromes. The analysis of the architecture and phasing of sleep stages has been proposed as a biological marker to separate anxiety and depression. The modification of REM and delta sleep has been correlated with antidepressant action.
The earliest studies of trimipramine noted antidepressant, anxiolytic and hypnotic effects. Further observations have shown this drug to have atypical effects on REM sleep. In addition, despite its structural similarity to other tricyclic antidepressants, its pharmacological profile in animals is very different: there is no synaptosomal reuptake of serotonin or nor adrenaline, and no desensitisation of β-adrenoceptors after long term administration.
A series of studies was carried out on 99 patients. Admission criteria for the studies specified a minimum score of 20 on the Anxiety Status Inventory as well as the presence of moderate depression. An uncontrolled trial demonstrated the anxiolytic efficacy of trimipramine. Further controlled trials showed superior anxiolytic efficacy of trimipramine to amitriptyline and doxepin with comparable anxiolytic efficacy of trimipramine with maprotiline. All agents had equal antidepressant effects.
KeywordsAmitriptyline Doxepin Maprotiline Trimipramine Zimelidine
Unable to display preview. Download preview PDF.
- Akiskal H. Characterology manifestations of affective disorders: toward a new conceptualization. Integrative Psychiatry, May–June: 83–88, 1984Google Scholar
- Cournoyer G, de Montigny C, Ouellette J, Langlois R, Elie R, et al. A comparative double-blind study of trimipramine and amitriptyline in major depression: lack of correlation with 5-hydroxytryptamine reuptake blockade. Journal of Clinical Psychopharmacology 7: 385–393, 1987PubMedCrossRefGoogle Scholar
- Erutka I, Ban TA, Lehmann HE. The effect of trimipramine on newly admitted depressed patients. In Lehmann et al. (Eds) Trimipramine, a new anti-depressant, pp. 59–64, Phoenix Printing, Montreal, 1964Google Scholar
- Gardner CR. Pharmacological studies of the role of serotonin in animal models of anxiety. In Green AR (Ed.) Neuropharmacology of serotonin, pp. 281–235, Oxford University Press, 1985Google Scholar
- Gray JA. The neuropsychology of anxiety: an inquiry into the functions of the septo-hippocampal system. Oxford University Press, New York, 1982Google Scholar
- Juillet P, Dorey R, Coreau P, et al. Action de la trimeproprimine (7162 RP) dans certains états névrotiques. Annales de Medicopsychologie 120: 586–592, 1962Google Scholar
- Lambert PA, Guyotat J, Charriot G. La trimeproprimine (7162 RP) un nouvel antidepresseur a proprietes sedatives et tranquillisantes. Annales de Medico-psychologie 2: 713–717, 1961Google Scholar
- Leckman JF, Weissman MM, Merikangas KR, Pauls DL, Prusoff BA. Panic disorder and major depression. Increased risk of depression, alcoholism, panic, and phobic disorders in families of depressed probands with panic disorder. Archives of General Psychiatry 40: 1055–1060, 1983Google Scholar
- Pecknold JC. Anxiety depressions. In McClure DJ (Ed.) Unmasking the faces of depression, Rhône-Poulenc, in pressGoogle Scholar
- Pecknold JC, Ananth J, Van den Steen N, Krishnappa U. Trimipramine in the treatment of anxious-depressed outpatients. Current Therapeutic Research 23: 94–100, 1978Google Scholar
- Pecknold JC, McClure DJ, Elie R, et al. Trimipramine and amitriptyline: comparison in anxiety-depression. Current Therapeutic Research 26: 497–504, 1979Google Scholar
- Pecknold JC, McClure DJ, Chang H. Zimeldine, comparative study in depression. Current Therapeutic Research 38: 808–816, 1985Google Scholar
- Rickels K, Gordon PE, Weise CC. Amitriptyline and trimipramine in neurotic depressed outpatients: a collaborative study. American Journal of Psychiatry 12: 126–135, 1970Google Scholar
- Rifkin A, Saraf K, Kane J, et ai. A comparison of trimipramine and imipramine: a controlled study. Journal of Clinical Psychiatry 41: 124–129, 1960Google Scholar
- Rouleau Y. L’emploi de la trimipramine dans les états dépressifs. In Lehmann et al. (Eds) Trimipramine, a new antidepressant, pp. 65–68, Phoenix Printing, Montreal, 1964Google Scholar
- Sigwald J, Henne M, Bouttier D, Raymondeau C, Quetin A. Psychiatric and neurological activity of a new phenothiazine. Presse Médicale 87: 2011, 1956Google Scholar
- Temple DL, Yucca FD. Current perspectives on the mechanism of action of buspirone. Abstracts of the 15th CINP Meeting, San Juan, Puerto Rico, Dec 14–17, 1986, Abstract, p. 154Google Scholar
- Vidal G, Vidal B, Valery MB. Essais cliniques de la trimeproprimine (7162 RP). Annales de Medico-psychologie 2: 422, 1962Google Scholar
- Ware JC, Brown FW, Moorad PJ, et al. Comparison of trimipramine and imipramine in depressed insomniac patients. Sleep Research 14: 65, 1985Google Scholar
- Zung WWK. A rating instrument for anxiety disorders. Psychosomatics 12: 371–379, 1975Google Scholar