Differential effects on suicidal ideation of mianserin, maprotiline and amitriptyline.

Eighty patients suffering from primary depressive illness were treated for 4 weeks, following a 7-d (at least) no-treatment period, with either mianserin 60 mg daily ( = 50), maprotiline 150 mg at night-time ( = 15) or amitriptyline 150 mg at night-time ( = 15) in double-blind controlled trials run concurrently in the same hospital on protocols having the same design and entry criteria. The effects of the three drugs were examined for their profile of action using a new depression rating scale (Montgomery and Åsberg Depression Scale, MADS) claimed to be more sensitive to change. There was no significant difference in mean entry scores or mean amelioration of depression on the MADS or the Hamilton Rating Scale (HRS) between the three drugs, but individual items on the MADS did show significant differences in amelioration. A highly significant ( < 0.01) difference was observed in favour of mianserin against maprotiline on both items of suicidal thoughts' and pessimistic thoughts' on the MADS. The suicidal item on the HRS showed a similar tendency which did not reach significance. This finding is considered in relation to a possible mode of action of mianserin and the relevance to reported subgroups of depressive illness with increased suicidal ideation. The increasing problems of self-poisoning with tricyclic and tetracyclic antidepressants are discussed in relation to the reported relative lack of toxicity of mianserin.