The Choice of Alternative Antidepressants

The present report, based upon a partial analysis of data gathered during a study of response to antidepressant medication, is distinctive in the particular sense that it attempts to anticipate individual differences which could have emerged during the course of treatment. The present analysis is not concerned with the post-treatment individual differences. Studies limited to post-treatment individual differences may lose or obscure some important differences in response which characterize fast and effective therapy. Since the predictive emphasis is on individual differences that occur in the course of treatment, predictor-criteria relationships that existed before treatment began or that occurred in the first week of treatment only were disregarded. Specifically, in the present analyses, the predictive emphasis is on those relationships which appeared to have been strengthened after the first week and were discernible in both the second and third weeks of treatment. The analyses were based on 157 depressed female patients newly admitted to the New Jersey State Hospital at Marlboro, and assigned on a random basis to amitriptyline, imipramine, or thioridazine. The present report examines weekly assessments of WPRS-S symptoms, the Depression and Psychasthenia scores of the MMPI, and a somatic distress inventory. The three medications were quite similar in their average effect, and the set of 24 criteria applied at the successive weekly assessment periods revealed very few significant contrasts. There was some tendency for the thioridazine patients to experience greater fatigue and nasal stuffiness than the other patients. Although average treatment effects could not be offered as a guide to the selective assignment of these three medications, there were numerous indications of interaction within each treatment group, and these interactions suggest ways in which pretreatment characteristics of the patient may be used to guide the selective assignment of the available medications.