Mianserin plasma levels and differential clinical response in endogenous and reactive depression

Fifty patients with moderate to severe primary depression were treated in equal groups of inpatients and outpatients with a constant dose of 60 mg. of mianserin daily for four weeks in a double blind placebo controlled trial with either a three times daily dosage regime or a single nightly dose. There was no difference in apparent compliance, side effects or therapeutic effect in either day-time or night-time dosage regimes. Patients developing high plasma levels of mianserin (greater than 70 microgram/l) were associated with a highly significantly poorer therapeutic outcome. Patients identified as endogenous depression demonstrated a significant negative correlation between plasma levels of mianserin and therapeutic response measured as an amelioration of either the Hamilton Rating Scale scores (r = --0.48) or on a new depression scale by Montgomery and Asberg (r = --0.51) with high levels associated with poor response. There was a significant correlation (r = 0.66) between mianserin plasma levels and age in endogenous depression. In those patients identified as suffering from reactive depression, no significant relationship could be seen between plasma levels and therapeutic response or with age. These findings support the view that the relationship between mianserin plasma levels and clinical response is more likely to be demonstrated in endogenous depression.

A double-blind comparison of lithium carbonate and maprotiline in the prophylaxis of the affective disorders

A double-blind prospective study was carried out comparing the prophylactic effect of maprotiline and lithium carbonate over a period of one year in patients suffering from recurrent affective disorders. The average Affective Morbidity Index was lower, but not significantly so, in patients treated with lithium. A further analysis, based on dividing patients into those with no affective morbidity and those who showed some affective morbidity during the study, demonstrated lithium carbonate to be significantly superior to maprotiline both in the group as a whole and in unipolar depressives. A correlation between high plasma maprotiline concentration and low morbidity was observed and was in line with an earlier report. A highly significant negative correlation (r=-0-97; p less than 0-001) was found between plasma maprotiline concentration and body weight. Although the results showed lithium carbonate to be superior to maprotiline in the study, it should be emphasized that the plasma levels of lithium were constantly monitored and maintained at what is considered to be its optimum concentration, whereas the maprotiline treated patients were kept on a fixed dosage regime irrespective of plasma levels.