Brown R P, Kocsis J H, Glick I D, Dhar A K
J Clin Psychopharmacol. 1984 Dec;4(6):311-5.
It is unclear why delusional depressives respond poorly to usual doses of tricyclic antidepressants alone. Seventeen elderly, delusional depressives were treated with high doses of imipramine or desmethylimipramine while monitoring plasma levels in an open study. Four of seven patients who received an adequate trial responded, but over half of the total sample had to be dropped due to intolerable side effects or worsening clinical condition. Antidepressants in high doses may be effective for part of the delusional depression sample, but this potentially effective pharmacologic therapy is not feasible in a large percentage of elderly or agitated patients.
目前尚不清楚为何妄想性抑郁症患者单独使用常规剂量的三环类抗抑郁药疗效不佳。在一项开放性研究中，对17名老年妄想性抑郁症患者使用高剂量的丙咪嗪或去甲丙咪嗪进行治疗，并监测血浆水平。在接受充分试验的7名患者中，有4名有反应，但由于无法耐受的副作用或临床状况恶化，超过一半的总样本不得不退出研究。高剂量的抗抑郁药可能对部分妄想性抑郁症患者有效，但这种潜在有效的药物治疗方法对很大一部分老年或躁动患者并不可行。
