Amitriptyline in Depressive States

In recent years the development of effective anti-depressant drugs has led to much controversy and uncertainty regarding the treatment of depressive states. Indications for the primary use of E.C.T. remain obscure, whilst choice of drug seems to be determined by current personal preference rather than by any specific rationale. If reliable prognostic formulations—and so, rational lines of treatment—are to be developed, there is an urgent need for the accumulation of data from controlled trials rather than a continuing spate of “1”. Amitriptyline, a new anti-depressant chemically resembling both imipramine and chlorpromazine has, in a blind controlled study carried out by the authors, been shown to be significantly superior to imipramine in the treatment of female patients between 30 and 70 years of age, hospitalized with primary depressive states (Burt, Gordon, Holt and Hordern, 1962). The findings in the first 74 patients were unexpectedly so much in favour of amitriptyline that to confirm them the trial was extended to include a further 65 patients conforming to the same criteria; but as two died, the total sample consisted of 137 female patients. The size of this sample facilitated (1) an investigation of the phenomenology of depressive states in women and (2) a study of the significance of a number of prognostic variables in relation to the outcome of treatment with amitriptyline and imipramine.