Combined treatment with venlafaxine and tricyclic antidepressants in depressed patients who had partial response to clomipramine or imipramine: Initial findings

Background: We report, after 3 years of work, a case series showing our ini tial results (efficacy, tolerability, and safety) with the addition of venl afaxine immediate release (IR) to either clomipramine or imipramine in depr essed patients who had shown only partial response to maximal doses of one of those tricyclic antidepressants (TCAs) and no further improvement after addition of usual augmentation drugs. Method: Eleven patients were treated, 10 of them having a recurrent depress ive disorder (DSM-IV) and all of them having current major depression (DSM- IV) that in 9 patients was moderate or severe despite intense TCA treatment as well as usual augmentations. Under open and outpatient conditions, we m aintained TCA doses, discontinued previous augmentations, and then added ve nlafaxine IR to a maximum dosage, if necessary, of 150 mg every 12 hours. T here was no control group. Response was assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D), DSM-IV criteria, the Clinical Global Impressions-Severity of Illness scale, and persistence of improvements afte r 6 months. We measured clinical tolerance (using the UKU Side Effect Ratin g Scale), blood pressure and heart rate, electrocardiogram (ECG), and blood TCA levels after adding venlafaxine IR. Results: A sustained improvement (> 50% decrease in HAM-D score plus decrea se in DSM-IV severity level) appeared in 9 patients, and sustained full rem ission (DSM-IV criteria plus HAM-D score < 5) in 7. Panic-agoraphobic sympt oms improved in the 2 patients suffering from them. There were no dropouts, and tolerability was good. No significant changes in blood pressure and he art rate, EGG, or blood tricyclic levels were found. Conclusion: Addition of venlafaxine to clomipramine or imipramine could be an effective and safe augmentation strategy in depressive patients with par tial response to maximum-dose monotherapy. A consistent replication of thes e initial findings is strongly needed.