Trimipramine in the treatment of active duodenal ulceration

Evidence-based data on pain relief with antidepressants

This structured review addresses the issue of whether antidepressants have an antinociceptive (analgesic) effect for chronic pain independent of their antidepressant effect. In order to answer this question, human acute pain studies, individual placebo-controlled studies for the treatment of specific chronic pain syndromes, and metaanalytic studies were reviewed and placed into table format. Analysis of this evidence led to the following conclusions: The evidence was consistent in indicating that overall antidepressants may have an antinociceptive effect in chronic pain, and that these drugs were effective for neuropathic pain. There was also some evidence that these drugs could be effective for psychogenic or somatoform disorder-associated pain. This evidence also strongly suggested that serotonergic-noradrenergic antidepressants may have a more consistent antinociceptive effect than the serotonergic antidepressants. Finally, this evidence indicated that antidepressants could be effective for pain associated with some specific pain syndromes, such as chronic low back pain, osteoarthritis or rheumatoid arthritis, fibrositis or fibromyalgia, and ulcer healing. Possible reasons for the conflicting results of studies in this area are presented, and problems that could limit the validity of the conclusions of this review are discussed.

Life events stress and psychosocial factors in men with peptic ulcer disease. A multidimensional case-controlled study

We carried out a case-controlled study of multiple psychological and social factors in 49 men with complicated or uncomplicated peptic ulcer disease. Thirty-two men with renal stones or gallstones and 20 healthy men served as controls. Ulcer patients and controls experienced a similar number of potentially stressful life events. However, ulcer patients perceived their events more negatively (p less than 0.05). Ulcer patients also had significantly more personality disturbances than controls, although no one type of "ulcer personality" was found consistently. Some ulcer patients tended to be hypochondriacal complainers, overly pessimistic, and excessively dependent. Other personality disturbances were also more common in ulcer patients (e.g., immaturity, impulsivity, and feelings of social isolation and alienation). Ulcer patients had significantly lower ego strength and they had fewer friends and relatives whom they felt they could call upon in times of crisis. Finally, ulcer patients exhibited significantly more emotional distress in the form of depression and anxiety. Hypochondriasis, a negative perception of their life events, dependency, and lowered ego strength were the four variables that best discriminated ulcer patients from controls. This controlled study demonstrates a strong association between life events stress, psychosocial factors, and peptic ulcer disease.

Ranitidine hydrochloride

Ranitidine is a selective, competitive histamine H2-receptor antagonist recently approved by the Food and Drug Administration for use in the short-term treatment of active duodenal ulcers and gastric hypersecretory conditions. Ranitidine is four to ten times more potent than cimetidine on a molar basis in inhibiting stimulated gastric acid secretion. Clinical studies have demonstrated that ranitidine is as effective as cimetidine and is similarly well tolerated. Based on available literature (approximately 700 publications), this article reviews the pharmacology, safety profile, and clinical efficacy of ranitidine in duodenal ulcers and gastric hypersecretory conditions.

Comparative study of cimetidine and trimipramine in the short-term treatment of duodenal and gastric ulcer

Sixty-nine outpatients with endoscopically confirmed duodenal and prepyloric (DU) or gastric ulcers (GU) completed a 4-week double-blind trial with either cimetidine, 1 g/day, or trimipramine, 50 mg/day. Ulcer healing was assessed by endoscopy at 4 weeks. At the end of the study 14 of 23 patients with DU treated with cimetidine and 13 of 25 treated with trimipramine had healed ulcers. In the patients with GU 7 of 11 ulcers (cimetidine) and 4 of 10 (trimipramine) healed. The differences in healing rates between the two treatment groups were not statistically significant, either in DU and GU groups separately or in the total material. The number of pain attacks per week decreased and the symptoms improved significantly in both treatment groups in DU, GU, and totally. Both drugs were well tolerated, but two patients in each treatment group developed a slight increase in serum transaminases. No serious side effects occurred. The study suggests trimipramine as an alternative drug to the well-established drug cimetidine in the treatment of duodenal and possibly also of gastric ulcer.