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December 1986

Desipramine-Yohimbine Combination Treatment of Refractory Depression: Implications for the β-Adrenergic Receptor Hypothesis of Antidepressant Action

Author Affiliations

From the Clinical Neuroscience Research Unit, Ribicoff Research Facilities, Connecticut Mental Health Center, and the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.

Arch Gen Psychiatry. 1986;43(12):1155-1161. doi:10.1001/archpsyc.1986.01800120041009

• Preclinical investigations have shown that combined administration of the α2-adrenergic receptor antagonist yohimbine hydrochloride and the tricyclic antidepressant desipramine hydrochloride produces a reduction in brain β-adrenergic receptor function within four days. Since the ability of antidepressant treatments to reduce β-adrenergic receptor function has been hypothesized to mediate antidepressant efficacy, it was predicted that combined desipramine-yohimbine treatment would be a more rapid-acting and potent antidepressant regimen than desipramine alone. In the present investigation, the effects of desipramine (N=11) and desipramine-yohimbine (N=10) treatment on depressive symptoms, norepinephrine turnover, and blood pressure were determined in patients with major depression who had a history of nonresponse to standard antidepressant treatments. Neither desipramine nor desipramine-yohimbine proved to be an effective treatment, although concomitant yohimbine administration did attenuate the ability of desipramine to decrease plasma free and 24-hour urinary 3-methoxy-4-hydroxyphenylethyleneglycol levels and blood pressure. Fifteen of the 21 patients eventually had a good response to pharmacologic treatments, particularly a desipramine—lithium carbonate or lithium carbonate—tranylcypromine sulfate combination treatment (11 of 14 responded). This study provides evidence against the β-adrenergic receptor hypothesis of antidepressant action.

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