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Adjunctive Imipramine in the Treatment of Postpsychotic Depression: A Controlled Trial

Adjunctive Imipramine in the Treatment of Postpsychotic Depression: A Controlled Trial Abstract • The efficacy of adjunctive imipramine hydrochloride treatment for syndromally defined postpsychotic depression was assessed in a six-week, double-blind, placebo-controlled study. All patients had been diagnosed as having schizophrenia or schizoaffective disorder, all were receiving stable doses of fluphenazine decanoate, and all had received benztropine mesylate in an attempt to rule out neuroleptic-induced akinesia. Patients randomized to imipramine therapy fared significantly better in terms of their global improvement and in terms of individual symptoms that are components of the depression syndrome. There were no significant differences in outcome psychosis ratings or side effects. This study indicates the existence of an identifiable syndrome of secondary depression in this patient group that is likely to respond favorably to treatment with adjunctive imipramine. References 1. Bleuler E: Dementia Praecox or the Group of Schizophrenia . New York, International Universities Press Inc, 1950. 2. GAP Report #102: The Chronic Mental Patient in the Community. New York, Group for the Advancement of Psychiatry, 1978. 3. Semrad EV: Long-term therapy of schizophrenia , in Usdin G (ed): Psychoneurosis and Schizophrenia . New York, JB Lippincott, 1966, pp 155-173. 4. Shanfield S, Tucker GJ, Harrow M, Detre T: The schizophrenic patient and depressive symptomatology . J Nerv Ment Dis 1970;151:203-210.Crossref 5. Winokur G: Family history studies: VIII. Depression is alive and well . Dis Nerv Syst 1972;33:94-99. 6. DeAlarcon R: Detection and management of affective disturbance in schizophrenia , in Lader MH (ed): Studies of Schizophrenia. BrJ Psychiatry 1975;10(special publication):137-141. 7. Weissman MM, Pottenger M, Kleberg H, Ruben HL, Williams D, Thompson WD: Symptom patterns in primary and secondary depression: A comparison of primary depressives with depressed opiate addicts, alcoholics, and schizophrenics . Arch Gen Psychiatry 1977;34:854-862.Crossref 8. Sheldrick C, Jablenski A, Sartorius N, Sheperd M; Schizophrenia succeeded by affective illness: Catamnestic study and statistical enquiry . Psychol Med 1977;7:619-624.Crossref 9. Cheadle AJ, Freeman HL, Korer J: Chronic schizophrenic patients in the community . BrJ Psychiatry 1978;132:221-227. 10. Huber G, Gross G, Schuttler R, Linz M: Longitudinal studies of schizophrenic patients . Schizophr Bull 1980;6:592-605.Crossref 11. Knights A, Hirsch SR: 'Revealed' depression and drug treatment for schizophrenia . Arch Gen Psychiatry 1981;38:806-811.Crossref 12. Roy A, Thompson R, Kennedy S: Depression in chronic schizophrenia . Br J Psychiatry 1983;142:465-470.Crossref 13. Summers F, Harrow M, Westermeyer J: Neurotic symptoms in the post-acute phase of schizophrenia . J Nerv Ment Dis 1983;171:216-221.Crossref 14. Armbruster B, Gross G, Huber G: Long-term prognosis and course of schizoaffective schizophreniform, and cycloid psychoses . Psychiatr Clin 1983;16:156-168. 15. Strauss JS: Schizoaffective disorders: 'Just another illness' or key to understanding the psychoses . Psychiatr Clin 1983;16:286-296. 16. Steinberg HR, Green R, Durell J: Depression occurring during the course of recovery from schizophrenic symptoms . Am J Psychiatry 1967;124:669-702. 17. Roth S: The seemingly ubiquitous depression following acute schizophrenic episodes: A neglected area of clinical discussion . Am J Psychiatry 1970;127:91-98. 18. Stern MJ, Pillsbury JA, Sonnenberg SM: Post-psychotic depression in schizophrenics . Compr Psychiatry 1972;13:591-598.Crossref 19. Rada RT, Donlon PJ: Depression and the acute schizophrenic process . Psychosomatics 1975;16:116-119.Crossref 20. McGlashan TH, Carpenter WT Jr: Post-psychotic depression in schizophrenia . Arch Gen Psychiatry 1976;33:231-241.Crossref 21. McGlashon TH, Carpenter WT: An investigation of the post-psychotic depressive syndrome . Am J Psychiatry 1976;133:14-19. 22. MacKinnon BL: Post-psychotic depression and the need for personal significance . Am J Psychiatry 1977;134:427-429. 23. Knights A, Okasha MS, Salih MA, Hirsch SR: Depressive and extrapyramidal symptoms and clinical effects: A trial of fluphenazine versus flupenthixol in maintenance of schizophrenia outpatients . Br J Psychiatry 1979;135:515-523.Crossref 24. Siris SG, Harmon GK, Endicott J: Post-psychotic depressive symptoms in hospitalized schizophrenic patients . Arch Gen Psychiatry 1981;38:1122-1123.Crossref 25. Johnson DAW: Studies of depressive symptoms in schizophrenia . BrJ Psychiatry 1981;139:89-101.Crossref 26. Mandel MR, Severe JB, Schooler NR, Gelenberg AJ, Mieske M: Development and prediction of post-psychotic depression in neuroleptictreated schizophrenics . Arch Gen Psychiatry 1982;39:197-203.Crossref 27. Moller H-J, von Zerssen D: Depressive states occurring during the neuroleptic treatment of schizophrenia . Schizophr Bull 1982;8:109-117.Crossref 28. Guze SB, Cloninger R, Martin RL, Clayton PJ: A follow-up and family study of schizophrenia . Arch Gen Psychiatry 1983;40:1273-1276.Crossref 29. Tsuang MT: Suicide in schizophrenics, manics, depressives, and surgical controls . Arch Gen Psychiatry 1978;35:153-155.Crossref 30. Roy A: Suicide in chronic schizophrenia . Br J Psychiatr 1982;141:171-177.Crossref 31. Roy A: Risk factors for suicide in psychiatric patients . Arch Gen Psychiatry 1982;39:1089-1095.Crossref 32. Wilkinson DG: The suicide rate in schizophrenia . Br J Psychiatry 1982;140:138-141Crossref 33. Morrison JR: Suicide in a psychiatric practice population . J Clin Psychiatry 1982;43:348-352. 34. Hillard JR, Ramm D, Zung WWK, Holland JM: Suicide in a psychiatric emergency room population . Am J Psychiatry 1983;140:459-462. 35. Brier A, Astrachan BM: Characterization of schizophrenic patients who commit suicide . Am J Psychiatry 1984;141:206-209. 36. Michaux MH, Kurland AA, Agallianos DD: Chlorpromazine-chlordiazepoxide and chlorpromazine-imipramine treatment of newly hospitalized, acutely ill psychiatric patients . Curr Ther Res 1966;8:117-152. 37. Hanlon TE, Ota KY, Kurland AA: Comparative effects of fluphenazine-chlordiazepoxide and fluphenazine-imipramine . Dis Nerv Syst 1970;31:171-177. 38. Kurland AA, Hanlon TE, Ota KY: Combinations of psychotherapeutic drugs in the treatment of the acutely disturbed psychiatric patient , in Vinar O, Votava Z, Bradley PB (eds): Advances in Neuropsychopharmacology . Amsterdam, North-Holland Publishing Co, 1971, pp 419-424. 39. Hedberg DL, Houck JH, Glueck BC Jr: Tranylcypromine-trifluoperazine combination in the treatment of schizophrenia . Am J Psychiatry 1971;127:1141-1146. 40. Detre TP, Jarecki HG: Modern Psychiatric Treatment . New York, JB Lippincott, 1971, p 134. 41. Pishkin V: Concept identification and psychophysiological parameters in depressed schizophrenics as functions of imipramine and nialamide . J Clin Psychol 1972;28:335-339.Crossref 42. Chouinard G, Annable L, Serrano M, Albert JM, Charette R: Amitriptyline-perphenazine interaction in ambulatory schizophrenic patients . Arch Gen Psychiatry 1975;32:1295-1307.Crossref 43. Siris SG, van Kammen DP, Docherty JP: Use of antidepressant drugs in schizophrenia . Arch Gen Psychiatry 1978;35:1368-1377.Crossref 44. Michaux MH, Kurland AA: Combined psychotropic drug therapy . Dis Nerv Syst 1963;34:739-741. 45. Sheppard C, Collins L, Fiorentino D, Fracchia J, Merlis S: Polypharmacy in psychiatric treatment: I. Incidence at a state hospital . Curr Ther Res 1969;11:765-774. 46. Laska E, Varga E, Wanderling J, Simpson G, Lodgeman GW, Shah BK: Patterns of psychotropic drug use for schizophrenia . Dis Nerv Syst 1973;34:294-305. 47. Sheppard C, Beyel V, Fracchia J: Polypharmacy in psychiatry: A multistate comparison of psychotropic drug combinations . Dis Nerv Syst 1974;35:183-189. 48. Singh AN, Saxena B, Nelson HL: A controlled clinical study of trazodone in chronic schizophrenic patients with pronounced depressive symptomatology . Curr Ther Res 1978;23:485-501. 49. Waehrens J, Gerlach J: Antidepressant drugs in anergic schizophrenia: A double-blind cross-over study with maprotiline and placebo . Acta Psychiatr Scand 1980;61:438-444.Crossref 50. Kurland AA, Nagaraju A: Viloxazine and the depressed schizophrenic: Methodological issues . J Clin Pharmacol 1981;21:37-41.Crossref 51. Prusoff BA, Williams DH, Weissman MM, Astrachan BM: Treatment of secondary depression in schizophrenia . Arch Gen Psychiatry 1979;36:569-575.Crossref 52. Rifkin A, Quitkin F, Klein DF: Akinesia . Arch Gen Psychiatry 1975;32:672-674.Crossref 53. Rifkin A, Quitkin F, Kane J, Struve F, Klein DF: Are prophylactic antiparkinson drugs necessary? Arch Gen Psychiatry 1978;35:483-489.Crossref 54. Van Putten T, May PR: 'Akinetic depression' in schizophrenia . Arch Gen Psychiatry 1978;35:1101-1107.Crossref 55. Astrachan BM, Harrow M, Adler D, Bauer L, Schwartz A, Schwartz C, Tucker G: A checklist for the diagnoses of schizophrenia . BrJ Psychiatry 1972;121:529-539.Crossref 56. Raskin A, Schulterbrandt JG, Reatig N, Chase C, McKeon J: Differential response to chlorpromazine, imipramine, and placebo . Arch Gen Psychiatry 1970;23:164-173.Crossref 57. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 58. Asberg M, Cronholm B, Sjoqvist F, Tuck D: Relationship between plasma level and therapeutic effect of nortriptyline . Br Med J 1971;3:331-334.Crossref 59. Kragh-Sorensen P, Hansen C, Baastrup R, Hvidberg EF: Selfinhibiting action of nortriptyline's antidepressive effect at high plasma levels . Psychopharmacologia 1976;45:305-312.Crossref 60. Ziegler V, Clayton P, Taylor J, Co BT, Biggs JT: Nortriptyline plasma levels and therapeutic response . Clin Pharmacol Ther 1976;20:458-463. 61. Siris SG, Cooper TB, Rifkin A, Brenner R, Lieberman J: Plasma imipramine concentrations in patients receiving concomitant fluphenazine decanoate . Am J Psychiatry 1982;139:104-106. 62. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 63. Endicott J, Spitzer RL: A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 1978;35:837-844.Crossref 64. Guy W:ECDEU Assessment Manual, publication76-338. US Dept of Health, Education, and Welfare, 1976. 65. Suckow RF, Cooper TB: Simultaneous determination of imipramine, desipramine and their 2-hydroxy metabolites in plasma by ion-pair reversed-phase high-performance liquid chromatography with amperometric detection . J Pharm Sci 1981;70:257-261.Crossref 66. Endicott J, Spitzer RL, Fleiss JL, Cohen J: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;33:766-771.Crossref 67. Endicott J, Cohen J, Nee J, Fleiss J, Sarantakos S: Hamilton Depression Rating Scale: Extracted from regular and change versions of the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 1981;38:98-103.Crossref 68. Becker RE: Implications of the efficacy of thiothixene and a chlorpromazine-imipramine combination for depression in schizophrenia . Am J Psychiatry 1983;140:208-211. 69. Siris SG, Rifkin A, Reardon GT, November M: Comparative side effects to imipramine, benztropine, or their combination, in patients receiving fluphenazine decanoate . Am J Psychiatry 1983;140:1069-1071. 70. Siris SG, Rifkin A, Reardon GT, Doddi SR, Strahan A, Hall KS: Stability of the post-psychotic depression syndrome . J Clin Psychiatry 1986;47:86-88. 71. Docherty JP, van Kammen DP, Siris SG, Marder SR: Stages of onset of schizophrenic psychosis . Am J Psychiatry 1978;135:420-426. 72. Siris SG, Rifkin A, Reardon GT: Response of post-psychotic depression to adjunctive imipramine or amitriptyline . J Clin Psychiatry 1982;43:485-486. 73. Gram L, Reisby N, Ibsen I, Nagy A, Dencker SJ, Beck P, Peterson GO, Christiansen J: Plasma levels and antidepressant effect of imipramine . Clin Pharmacol Ther 1976;19:318-324. 74. Glassman A, Perel J, Shostak M, Kantor S, Fleiss J: Clinical implications of imipramine plasma levels for depressive illness . Arch Gen Psychiatry 1977;34:197-204.Crossref 75. Siris SG, Glassman AH, Stetner F: The value of plasma concentrations in assessing the effects of tricyclic antidepressants , in Schoolar JC, Claghorn JL (eds): The Kinetics of Psychiatric Drugs . New York, Brunner/ Mazel Inc, 1979, pp 215-223. 76. Klein DF, Gittleman R, Quitkin F, Rifkin A: Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children . Baltimore, Williams & Wilkins, 1980. 77. Meltzer HY, Arora RC, Metz J: Biological studies of schizoaffective disorders . Schizophr Bull 1984;10:49-70.Crossref 78. Harrow M, Grossman LS: Outcome in schizoaffective disorders: A critical review and reevaluation of the literature . Schizophr Bull 1984;10:87-108.Crossref 79. Pope HG, Lipinski JF: Diagnosis in schizophrenia and manic-depressive illness . Arch Gen Psychiatry 1978;35:811-828.Crossref 80. Pope HG, Lipinski JF, Cohen BM, Axelrod DT: 'Schizoaffective disorder': An invalid diagnosis? A comparison of schizoaffective disorder, schizophrenia, and affective disorder . Am J Psychiatry 1980;137:921-927. 81. Procci WR: Schizoaffective psychosis: Fact or fiction? A survey of the literature . Arch Gen Psychiatry 1976;33:1167-1178.Crossref 82. Pi EH, Surawicz FG: Schizoaffective disorder (schneiderian positive), manic type: A comparison with mania . J Clin Psychiatry 1982;43:235-236. 83. Tsuang MT, Dempsey M, Rauscher F: A study of 'atypical schizophrenia': Comparison with schizophrenia and affective disorder by sex, age of admission, precipitant, outcome, and family history . Arch Gen Psychiatry 1976;33:1157-1160.Crossref 84. Brockington IF, Wainwright S, Kendell RE: Manic patients with schizophrenic or paranoid symptoms . Psychol Med 1980;10:73-83.Crossref 85. Tsuang MT, Woolson RF, Winokur G, Crow RR: Stability of psychiatric diagnosis: Schizophrenia and affective disorders followed up over a 30-to 40-year period . Arch Gen Psychiatry 1981;38:535-539.Crossref 86. Siris SG, Rifkin A, Reardon GT, Endicott J, Periera DH, Hayes R, Casey E: Course-related depressive syndromes in schizophrenia . Am J Psychiatry 1984;141:1254-1257. 87. American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 88. Fogelson DL, Cohen BM, Pope HG: A study of DSM III schizophreniform disorder . Am J Psychiatry 1982;139:1281-1285. 89. Siris SG, Rifkin A: Side effects of drugs used in the treatment of affective disorders , in Rifkin A (ed): Schizophrenia and Affective Disorders: Biology and Drug Treatment . Littleton, Mass, John Wright-PSG Inc, 1983, pp 117-138. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Adjunctive Imipramine in the Treatment of Postpsychotic Depression: A Controlled Trial

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American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-990X
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1598-3636
DOI
10.1001/archpsyc.1987.01800180043008
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Abstract

Abstract • The efficacy of adjunctive imipramine hydrochloride treatment for syndromally defined postpsychotic depression was assessed in a six-week, double-blind, placebo-controlled study. All patients had been diagnosed as having schizophrenia or schizoaffective disorder, all were receiving stable doses of fluphenazine decanoate, and all had received benztropine mesylate in an attempt to rule out neuroleptic-induced akinesia. Patients randomized to imipramine therapy fared significantly better in terms of their global improvement and in terms of individual symptoms that are components of the depression syndrome. There were no significant differences in outcome psychosis ratings or side effects. This study indicates the existence of an identifiable syndrome of secondary depression in this patient group that is likely to respond favorably to treatment with adjunctive imipramine. References 1. Bleuler E: Dementia Praecox or the Group of Schizophrenia . New York, International Universities Press Inc, 1950. 2. GAP Report #102: The Chronic Mental Patient in the Community. New York, Group for the Advancement of Psychiatry, 1978. 3. Semrad EV: Long-term therapy of schizophrenia , in Usdin G (ed): Psychoneurosis and Schizophrenia . New York, JB Lippincott, 1966, pp 155-173. 4. Shanfield S, Tucker GJ, Harrow M, Detre T: The schizophrenic patient and depressive symptomatology . J Nerv Ment Dis 1970;151:203-210.Crossref 5. Winokur G: Family history studies: VIII. Depression is alive and well . Dis Nerv Syst 1972;33:94-99. 6. DeAlarcon R: Detection and management of affective disturbance in schizophrenia , in Lader MH (ed): Studies of Schizophrenia. BrJ Psychiatry 1975;10(special publication):137-141. 7. Weissman MM, Pottenger M, Kleberg H, Ruben HL, Williams D, Thompson WD: Symptom patterns in primary and secondary depression: A comparison of primary depressives with depressed opiate addicts, alcoholics, and schizophrenics . Arch Gen Psychiatry 1977;34:854-862.Crossref 8. Sheldrick C, Jablenski A, Sartorius N, Sheperd M; Schizophrenia succeeded by affective illness: Catamnestic study and statistical enquiry . Psychol Med 1977;7:619-624.Crossref 9. Cheadle AJ, Freeman HL, Korer J: Chronic schizophrenic patients in the community . BrJ Psychiatry 1978;132:221-227. 10. Huber G, Gross G, Schuttler R, Linz M: Longitudinal studies of schizophrenic patients . Schizophr Bull 1980;6:592-605.Crossref 11. Knights A, Hirsch SR: 'Revealed' depression and drug treatment for schizophrenia . Arch Gen Psychiatry 1981;38:806-811.Crossref 12. Roy A, Thompson R, Kennedy S: Depression in chronic schizophrenia . Br J Psychiatry 1983;142:465-470.Crossref 13. Summers F, Harrow M, Westermeyer J: Neurotic symptoms in the post-acute phase of schizophrenia . J Nerv Ment Dis 1983;171:216-221.Crossref 14. Armbruster B, Gross G, Huber G: Long-term prognosis and course of schizoaffective schizophreniform, and cycloid psychoses . Psychiatr Clin 1983;16:156-168. 15. Strauss JS: Schizoaffective disorders: 'Just another illness' or key to understanding the psychoses . Psychiatr Clin 1983;16:286-296. 16. Steinberg HR, Green R, Durell J: Depression occurring during the course of recovery from schizophrenic symptoms . Am J Psychiatry 1967;124:669-702. 17. Roth S: The seemingly ubiquitous depression following acute schizophrenic episodes: A neglected area of clinical discussion . Am J Psychiatry 1970;127:91-98. 18. Stern MJ, Pillsbury JA, Sonnenberg SM: Post-psychotic depression in schizophrenics . Compr Psychiatry 1972;13:591-598.Crossref 19. Rada RT, Donlon PJ: Depression and the acute schizophrenic process . Psychosomatics 1975;16:116-119.Crossref 20. McGlashan TH, Carpenter WT Jr: Post-psychotic depression in schizophrenia . Arch Gen Psychiatry 1976;33:231-241.Crossref 21. McGlashon TH, Carpenter WT: An investigation of the post-psychotic depressive syndrome . Am J Psychiatry 1976;133:14-19. 22. MacKinnon BL: Post-psychotic depression and the need for personal significance . Am J Psychiatry 1977;134:427-429. 23. Knights A, Okasha MS, Salih MA, Hirsch SR: Depressive and extrapyramidal symptoms and clinical effects: A trial of fluphenazine versus flupenthixol in maintenance of schizophrenia outpatients . Br J Psychiatry 1979;135:515-523.Crossref 24. Siris SG, Harmon GK, Endicott J: Post-psychotic depressive symptoms in hospitalized schizophrenic patients . Arch Gen Psychiatry 1981;38:1122-1123.Crossref 25. Johnson DAW: Studies of depressive symptoms in schizophrenia . BrJ Psychiatry 1981;139:89-101.Crossref 26. Mandel MR, Severe JB, Schooler NR, Gelenberg AJ, Mieske M: Development and prediction of post-psychotic depression in neuroleptictreated schizophrenics . Arch Gen Psychiatry 1982;39:197-203.Crossref 27. Moller H-J, von Zerssen D: Depressive states occurring during the neuroleptic treatment of schizophrenia . Schizophr Bull 1982;8:109-117.Crossref 28. Guze SB, Cloninger R, Martin RL, Clayton PJ: A follow-up and family study of schizophrenia . Arch Gen Psychiatry 1983;40:1273-1276.Crossref 29. Tsuang MT: Suicide in schizophrenics, manics, depressives, and surgical controls . Arch Gen Psychiatry 1978;35:153-155.Crossref 30. Roy A: Suicide in chronic schizophrenia . Br J Psychiatr 1982;141:171-177.Crossref 31. Roy A: Risk factors for suicide in psychiatric patients . Arch Gen Psychiatry 1982;39:1089-1095.Crossref 32. Wilkinson DG: The suicide rate in schizophrenia . Br J Psychiatry 1982;140:138-141Crossref 33. Morrison JR: Suicide in a psychiatric practice population . J Clin Psychiatry 1982;43:348-352. 34. Hillard JR, Ramm D, Zung WWK, Holland JM: Suicide in a psychiatric emergency room population . Am J Psychiatry 1983;140:459-462. 35. Brier A, Astrachan BM: Characterization of schizophrenic patients who commit suicide . Am J Psychiatry 1984;141:206-209. 36. Michaux MH, Kurland AA, Agallianos DD: Chlorpromazine-chlordiazepoxide and chlorpromazine-imipramine treatment of newly hospitalized, acutely ill psychiatric patients . Curr Ther Res 1966;8:117-152. 37. Hanlon TE, Ota KY, Kurland AA: Comparative effects of fluphenazine-chlordiazepoxide and fluphenazine-imipramine . Dis Nerv Syst 1970;31:171-177. 38. Kurland AA, Hanlon TE, Ota KY: Combinations of psychotherapeutic drugs in the treatment of the acutely disturbed psychiatric patient , in Vinar O, Votava Z, Bradley PB (eds): Advances in Neuropsychopharmacology . Amsterdam, North-Holland Publishing Co, 1971, pp 419-424. 39. Hedberg DL, Houck JH, Glueck BC Jr: Tranylcypromine-trifluoperazine combination in the treatment of schizophrenia . Am J Psychiatry 1971;127:1141-1146. 40. Detre TP, Jarecki HG: Modern Psychiatric Treatment . New York, JB Lippincott, 1971, p 134. 41. Pishkin V: Concept identification and psychophysiological parameters in depressed schizophrenics as functions of imipramine and nialamide . J Clin Psychol 1972;28:335-339.Crossref 42. Chouinard G, Annable L, Serrano M, Albert JM, Charette R: Amitriptyline-perphenazine interaction in ambulatory schizophrenic patients . Arch Gen Psychiatry 1975;32:1295-1307.Crossref 43. Siris SG, van Kammen DP, Docherty JP: Use of antidepressant drugs in schizophrenia . Arch Gen Psychiatry 1978;35:1368-1377.Crossref 44. Michaux MH, Kurland AA: Combined psychotropic drug therapy . Dis Nerv Syst 1963;34:739-741. 45. Sheppard C, Collins L, Fiorentino D, Fracchia J, Merlis S: Polypharmacy in psychiatric treatment: I. Incidence at a state hospital . Curr Ther Res 1969;11:765-774. 46. Laska E, Varga E, Wanderling J, Simpson G, Lodgeman GW, Shah BK: Patterns of psychotropic drug use for schizophrenia . Dis Nerv Syst 1973;34:294-305. 47. Sheppard C, Beyel V, Fracchia J: Polypharmacy in psychiatry: A multistate comparison of psychotropic drug combinations . Dis Nerv Syst 1974;35:183-189. 48. Singh AN, Saxena B, Nelson HL: A controlled clinical study of trazodone in chronic schizophrenic patients with pronounced depressive symptomatology . Curr Ther Res 1978;23:485-501. 49. Waehrens J, Gerlach J: Antidepressant drugs in anergic schizophrenia: A double-blind cross-over study with maprotiline and placebo . Acta Psychiatr Scand 1980;61:438-444.Crossref 50. Kurland AA, Nagaraju A: Viloxazine and the depressed schizophrenic: Methodological issues . J Clin Pharmacol 1981;21:37-41.Crossref 51. Prusoff BA, Williams DH, Weissman MM, Astrachan BM: Treatment of secondary depression in schizophrenia . Arch Gen Psychiatry 1979;36:569-575.Crossref 52. Rifkin A, Quitkin F, Klein DF: Akinesia . Arch Gen Psychiatry 1975;32:672-674.Crossref 53. Rifkin A, Quitkin F, Kane J, Struve F, Klein DF: Are prophylactic antiparkinson drugs necessary? Arch Gen Psychiatry 1978;35:483-489.Crossref 54. Van Putten T, May PR: 'Akinetic depression' in schizophrenia . Arch Gen Psychiatry 1978;35:1101-1107.Crossref 55. Astrachan BM, Harrow M, Adler D, Bauer L, Schwartz A, Schwartz C, Tucker G: A checklist for the diagnoses of schizophrenia . BrJ Psychiatry 1972;121:529-539.Crossref 56. Raskin A, Schulterbrandt JG, Reatig N, Chase C, McKeon J: Differential response to chlorpromazine, imipramine, and placebo . Arch Gen Psychiatry 1970;23:164-173.Crossref 57. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 58. Asberg M, Cronholm B, Sjoqvist F, Tuck D: Relationship between plasma level and therapeutic effect of nortriptyline . Br Med J 1971;3:331-334.Crossref 59. Kragh-Sorensen P, Hansen C, Baastrup R, Hvidberg EF: Selfinhibiting action of nortriptyline's antidepressive effect at high plasma levels . Psychopharmacologia 1976;45:305-312.Crossref 60. Ziegler V, Clayton P, Taylor J, Co BT, Biggs JT: Nortriptyline plasma levels and therapeutic response . Clin Pharmacol Ther 1976;20:458-463. 61. Siris SG, Cooper TB, Rifkin A, Brenner R, Lieberman J: Plasma imipramine concentrations in patients receiving concomitant fluphenazine decanoate . Am J Psychiatry 1982;139:104-106. 62. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 63. Endicott J, Spitzer RL: A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 1978;35:837-844.Crossref 64. Guy W:ECDEU Assessment Manual, publication76-338. US Dept of Health, Education, and Welfare, 1976. 65. Suckow RF, Cooper TB: Simultaneous determination of imipramine, desipramine and their 2-hydroxy metabolites in plasma by ion-pair reversed-phase high-performance liquid chromatography with amperometric detection . J Pharm Sci 1981;70:257-261.Crossref 66. Endicott J, Spitzer RL, Fleiss JL, Cohen J: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;33:766-771.Crossref 67. Endicott J, Cohen J, Nee J, Fleiss J, Sarantakos S: Hamilton Depression Rating Scale: Extracted from regular and change versions of the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 1981;38:98-103.Crossref 68. Becker RE: Implications of the efficacy of thiothixene and a chlorpromazine-imipramine combination for depression in schizophrenia . Am J Psychiatry 1983;140:208-211. 69. Siris SG, Rifkin A, Reardon GT, November M: Comparative side effects to imipramine, benztropine, or their combination, in patients receiving fluphenazine decanoate . Am J Psychiatry 1983;140:1069-1071. 70. Siris SG, Rifkin A, Reardon GT, Doddi SR, Strahan A, Hall KS: Stability of the post-psychotic depression syndrome . J Clin Psychiatry 1986;47:86-88. 71. Docherty JP, van Kammen DP, Siris SG, Marder SR: Stages of onset of schizophrenic psychosis . Am J Psychiatry 1978;135:420-426. 72. Siris SG, Rifkin A, Reardon GT: Response of post-psychotic depression to adjunctive imipramine or amitriptyline . J Clin Psychiatry 1982;43:485-486. 73. Gram L, Reisby N, Ibsen I, Nagy A, Dencker SJ, Beck P, Peterson GO, Christiansen J: Plasma levels and antidepressant effect of imipramine . Clin Pharmacol Ther 1976;19:318-324. 74. Glassman A, Perel J, Shostak M, Kantor S, Fleiss J: Clinical implications of imipramine plasma levels for depressive illness . Arch Gen Psychiatry 1977;34:197-204.Crossref 75. Siris SG, Glassman AH, Stetner F: The value of plasma concentrations in assessing the effects of tricyclic antidepressants , in Schoolar JC, Claghorn JL (eds): The Kinetics of Psychiatric Drugs . New York, Brunner/ Mazel Inc, 1979, pp 215-223. 76. 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Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jun 1, 1987

References