Antidepressant Therapy for the Geriatric Patient
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Abstract:
Tricyclic antidepressants followed by the monoamine oxidase inhibitors are the mainstays of pharmacological antidepressant treatment for the elderly in the United States. Lithium is useful in selected patients. The newer agents, such as mianserin, nomifensine, trazodone, maprotiline, and amoxapine, appear to be effective and, if the early data are confirmed, may produce fewer side effects than the current tricyclics and monoamine oxidase inhibitors.Keywords:
Maprotiline
Mianserin
Nomifensine
Trazodone
Tricyclic
Tricyclic antidepressant
Clomipramine
Phenelzine
Tricyclic antidepressants followed by the monoamine oxidase inhibitors are the mainstays of pharmacological antidepressant treatment for the elderly in the United States. Lithium is useful in selected patients. The newer agents, such as mianserin, nomifensine, trazodone, maprotiline, and amoxapine, appear to be effective and, if the early data are confirmed, may produce fewer side effects than the current tricyclics and monoamine oxidase inhibitors.
Maprotiline
Mianserin
Nomifensine
Trazodone
Tricyclic
Tricyclic antidepressant
Clomipramine
Phenelzine
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Imipramine-N-oxide, quinupramine, clomipramine, doxepin, maprotiline, amineptine, amoxapine, mianserin, minaprine, nomifensine, viloxacine, trazodone and lofepramine effects were studied on rat vas deferens responses to noradrenaline. Tissues were prepared in Krebs-Henseleit solution with and without adding cocaine. 17 beta-estradiol and propranolol for blocking neuronal and extraneuronal noradrenaline reuptake. In normal Krebs-Henseleit solution imipramine-N-oxide, nomifensine, viloxacine and lofepramine increased noradrenaline responses, while clomipramine, trazodone and doxepin behaved as competitive antagonists. When adding cocaine, 17 beta-estradiol and propranolol to the solution there was antagonism but no increase in responses.
Maprotiline
Trazodone
Nomifensine
Clomipramine
Mianserin
Doxepin
Vas deferens
Reuptake
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Mianserin
Nomifensine
Trazodone
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Maprotiline
Trazodone
Mianserin
Fluvoxamine
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The relative acute cardiovascular toxicity among three novel antidepressants : maprotiline, mianserin and nomifensine, has been assessed in conscious rabbits ip injected at 50 mg/kg, throughout a 150 min observation period. No death was observed in mianserin rabbits (n=6), but 3 in the maprotiline rabbits (n=8) and 1 death in the nomifensinegroup (n=8), within the 2 hours. Cardiac output and renal blood flow were determined by the radioactive Sephadex microspheres method. Cardiac output values were significantly lowered (-29%) at 120 min only in mianserin rabbits, whereas renal blood flow values were reduced by 46.8% (mianserin, 35.8% (maprotiline) and 28%(nomifensine)at 120 min. In mianserin and maprotiline rabbits left ventricular pressure and mean arterial pressure fell significantly, but remained unchanged in nomifensinegroup. ECG disturbances consisting of ventricular and supraventricular extrasystoles were seen in all the injected rabbits, but QRS widening and right bundle branch block were solely observed after maprotiline and mianserin. Nomifensine rabbits experienced severe seizures with hypo-capnia and metabolic acidosis. The drug myocardial/ plasma ratio ranged between 59.3 (maprotiline)13.25 (mianserin) and 0.92 (nomifensine). A rise in plasma catecholamines (epinephrine) was documented after mianserin but not after nomifensin and maproti1ine. Nomifensine exhi bi ted much lesser cardiotoxicity than mianserin and maprotiline at this dose (50 mg/kg), but induced more convulsions.
Maprotiline
Mianserin
Nomifensine
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Trazodone
Maprotiline
Bupropion
Nefazodone
Mianserin
Citalopram
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Nomifensine
Mianserin
Trazodone
Phenanthrenes
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The authors review four “second generation” antidepressants (maprotiline, amoxapine, trazodone, and nomifensine) in terms of action on biogenic amines and receptors, antidepressive efficacy, and adverse effects. Doxepin is used as a comparative agent and is similar to the prototypical tricyclic agents in all the above categories. Maprotiline is a selective noradrenergic agent, but shares a similar adverse effect profile with doxepin and may be associated with a high frequency of seizures in overdose. Amoxapine is a mixed action antidepressant with significant neuroleptic activity in vivo. Its adverse effect profile is highlighted by symptoms related to its neuroleptic activity, and seizures and acute renal failure in overdose. Trazodone is a selective serotonergic agent with low anticholinergic activity, and minimal morbidity/mortality in overdose. Reports of priapism, leading to impotence in some men, however, is of concern. Nomifensine is a potent noradrenergic and dopaminergic agent with low anticholinergic activity, and minimum cardiotoxicity and low morbidity/mortality in overdose. Its most important adverse effects include overstimulation and infrequent, usually reversible, immunologic hypersensitivity reactions. Trazodone and nomifensine have favorable profiles for use in the elderly. Trazodone may be more favorable in the anxious/agitated patient due to its sedative effects, whereas nomifensine may be more beneficial in the retarded, apathetic patient.
Nomifensine
Trazodone
Maprotiline
Doxepin
Mianserin
Tricyclic
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Maprotiline
Mianserin
Nomifensine
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The monoamine oxidase inhibitors (MAOI) and the tricyclic antidepressants (TCA) have been used for over 20 years, and another generation of antidepressants has now emerged. Only mianserin is available in Australia but viloxazine, clomipramine, nomifensine, maprotiline, iprindole and zimelidine have been used overseas for several years.
Maprotiline
Nomifensine
Mianserin
Clomipramine
Tricyclic
Moclobemide
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