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Tranylcypromine Plus Amitriptyline for Electroconvulsive Therapy–Resistant Depression

A Long-Term Study

Ferreira-Garcia, Rafael MD, MSc; da Rocha Freire, Rafael Christophe MD, PhD; Appolinário, José Carlos MD, PhD; Levitan, Michelle N. PhD; Halkjær-Lassen, Roseane Dorte BSN; Bueno, João Romildo MD, PhD; Nardi, Antonio E. MD, PhD

Journal of Clinical Psychopharmacology: October 2018 - Volume 38 - Issue 5 - p 502–504
doi: 10.1097/JCP.0000000000000945
Brief Reports

Background Few therapeutic options are available for patients with electroconvulsive therapy–resistant major depressive disorder (ECT-r MDD), leaving a substantial proportion of this population beyond treatment possibilities. The combination of monoamine oxidase inhibitors and tricyclic antidepressants could be a potential strategy for managing ECT-r MDD, and the specific association of amitriptyline and tranylcypromine may offer additional tolerability advantages. Although promising, in our knowledge, no studies have examined until now the effectiveness of this combination in ECT-r MDD.

Methods We report a retrospective cohort of 31 patients with ECT-r MDD treated in an open-label fashion with the combination of amitriptyline and tranylcypromine.

Results Overall, 80.6% of the sample met response criteria at the end of the first 12 weeks of treatment. Seventy-six percent (19 of 25) of the responders were followed for a mean of 9.37 ± 3.86 years. During this follow-up period, none of the patients had a recurring depressive episode. The combination was well tolerated, whereas minor adverse effects were common, and no severe or life-threatening events were reported throughout the study.

Conclusions These findings indicate that the combination tranylcypromine and amitriptyline is a potentially safe and effective candidate for future investigation in the treatment and long-term maintenance of ECT-r MDD.

From the Laboratory of Panic and Respiration, Resistant Depression Outpatient Clinic, Instituto de Psiquiatria–Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Received March 5, 2018; accepted after revision July 9, 2018.

Reprints: Rafael Ferreira-Garcia, MD, MSc, Instituto de Psiquiatria–Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 – Fundos, Botafogo, Rio de Janeiro, RJ CEP 22290-140, Brazil (e-mail:

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