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May 1978

A Comparison of Electroconvulsive Therapy and Combined Phenelzine-Amitriptyline in Refractory Depression

Author Affiliations

From the Department of Psychiatry, Duke University, Durham, NC (Drs McLeod and Linnoila); John Umstead Hospital, Butner, NC (Drs Davidson, McLeod, and Law-Yone); and the Department of Psychiatry, University of North Carolina, Chapel Hill (Drs Davidson and Law-Yone). Dr Davidson is now with Burroughs Wellcome Co, Research Triangle Park, NC.

Arch Gen Psychiatry. 1978;35(5):639-642. doi:10.1001/archpsyc.1978.01770290121011

• Combined monoamine oxidase (MAO) inhibitor-tricyclic antidepressant therapy and electroconvulsive therapy (ECT) were compared in a population of refractory depressive patients. Seventeen patients were randomly assigned to either of the treatment groups, and an independent observer was used to rate overall progress. Between four and ten ECTs or a combination of phenelzine and amitriptyline were administered. Assays for MAO activity and plasma levels of amitriptyline and nortriptyline were performed. In both psychotic and neurotic depression, ECT was superior. When depression was accompanied by character disorder, the response was generally poor. Adequate levels of MAO inhibition were obtained, but tricyclic antidepressant levels were low. Electroconvulsive therapy is still considered to be the treatment of choice for severe depression, whereas the combination of low doses of phenelzine and amitriptyline are ineffective. This treatment modality needs further investigation.