Search

Patients with affective disorder insufficiently responding to prophylactic lithium present a major problem to maintenance pharmacotherapy. The present retrospective study tested the efficacy of carbamazepine in 73 such patients. The patients who were switched from lithium to carbamazepine monotherapy had additional benefit, but not those switched to combined lithium plus carbamazepine. This failure to replicate a number of recent pilot studies showing synergistic effects of lithium and carbamazepine may however have been due to a heterogeneity concerning the combined effects of some negative response predictors, although none of these was significant in itself. Nevertheless, synergism cannot be taken as guaranteed. Prospective controlled trials are needed.

In an open clinical trial, 13 depressives were treated with the reversible and selective type-A monoamine oxidase (MAO)-inhibitor brofaromine (CGP 11 305 A), the inhibitory potency of deproteinated plasma on a crude MAO preparation from human placenta was measured as a parameter for plasma brofaromine and possibly active metabolites of brofaromine. Patients significantly (p less than 0.01) improved under brofaromine. There were, however, no significant differences in plasma MAO-inhibitory potency between responders (improvement greater than 50%; n = 5) and nonresponders and no correlations with the change from baseline of the total Hamilton Depression Score (HAMD) or with changes of sleep (change from baseline of the HAMD sleep items). MAO-inhibitory potency significantly (p less than 0.05) increased parallel to the increase of the dosage from 50 mg b.i.d. to t.i.d., confirming the validity of this technique. The biological assay applied is a simple and reliable alternative when estimating the plasma concentrations of brofaromine and, possibly, other reversible MAO inhibitors.