Abstract
Objectives: Partial response or non-response to serotonergic agents is not an unusual clinical phenomenon. The addition of tri-cyclic antidepressants is a recognized technique in overcoming this phenomenon. The specific objectives of this study were to 1) assess the efficacy of desipramine augmentation on mood 2) determine the onset of noticeable mood change after desipramine augmentation and 3) determine the side effects of the combination.
Methods: The author reviewed the charts of patients who had desipramine augmentation as a result of partial or non-response to serotonergic antidepressants. Data were obtained on 1) duration of the depressive episode 2) dose and duration as well as degree of response to treatment with the serotonergic agent 4) dose of desipramine 5) side effects after desipramine augmentation 6) onset of noticeable mood change and 7) stability of response.
Summary of Results: Nine patients had desipramine added to serotonergic agents. 5/9 were on nefazodone, 1/9 on fluoxetine and 3/9 were on citalopram. Desipramine dose was from 25-50 mg. Of the 9 depressed patients who had desipramine augmentation, 6/9 achieved remission of the depressive episode, 1/9 had further partial response (but not remission), 1/9 switched to hypomania and 1/9 had no clinical response. Of the 5 patients for whom we had data regarding onset of response, 1/5 had onset on day 1, 4/5 had response on day 3. 8/9 did not report any side effects while 1/9 had excessive sweating. Of the 6 who achieved remission, 6/6 had persistent response up to the time of this study. Stability of response ranges from 6 to 48 weeks.
Conclusions: The author concludes that low dose desipramine augmentation (25–50 mg) to serotonergic agents can result in a rapid, safe and stable antidepressant response.