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Ask the Mental Health Expert Archives 2001-2004

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Depression Prescription

Q. What drugs were commonly prescribed for depression in the early 1960's?

A. There were very few medication options available for the treatment of depression in the early 1960s. The tricyclic antidepressant, imipramine (Tofranil and others) was investigated by Kuhn as early as 1958. Another tricyclic, amitriptyline (Elavil and others), was also introduced in the late 1950s, and was in clinical use as early as 1962.

Desipramine, nortriptyline, and other tricyclics followed shortly thereafter, and were in common use in the 1960s, 70s, and 80s--really up to the time that the so-called SSRIs were introduced in the late 1980s (Prozac, Zoloft, etc.). The tricyclics were very effective for depression, but had numerous side effects, such as dry mouth, sedation, and constipation. They were also extremely toxic when taken in overdose.

Another class of antidepressants--the monoamine oxidase inhibitors (MAOIs)--were also available in the late 1950s and early 1960s; however, iproniazid, a very effective MAOI, was withdrawn from the U.S. market in the early 1960s because of liver toxicity. Subsequently, in the 60s and early 70s, most U.S. psychiatrists considered the MAOIs too dangerous or difficult to use, and they fell out of favor. The MAOIs did not achieve significant use again until the late 70s and early 80s, mainly due to the research efforts of British investigators.

Of course, electroconvulsive therapy (ECT) was also available during this same historical period, though unfortunately, it was not always used wisely or well. (Modern-day use of ECT has improved considerably). Today, we have dozens of different medications for the treatment of clinically significant depression. Many of them have a greatly improved side effect profile, compared to the old tricyclics. The newer agents are also far less toxic if taken in overdose. Nevertheless, none of the newer agents has surpassed the tricyclics in terms of efficacy, and the tricyclics are still used today in resistant cases of major depression.

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March 2003

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