A double-blind study of tranylcypromine treatment of major anergic depression.

Fifty-nine anergically depressed patients were randomly assigned to 6 weeks of double-blind treatment with either tranylcypromine or placebo. Anergic major depression most typically occurs in primary bipolar and in pseudounipolar affective illnesses. We hypothesized that tranylcypromine would be a highly effective and rapid treatment for depressions of this type. Results of repeated measures analyses of variance showed superiority of active drug over placebo by the end of the first week, and this improvement increased in significance at each successive visit. Improvement on tranylcypromine after week 1 was greater than that on placebo after week 6. Analysis of covariance of week 6 scores (corrected for week 0 scores) showed significantly greater improvement for tranylcypromine patients on all measures of depressive symptomatology. Tranylcypromine is a rapid, relatively safe, and dramatically effective treatment for anergic depression. Since 24 of 29 of the bipolar subjects had previously failed to respond to tricyclics and since bipolar depression is usually anergic, tranylcypromine should be compared to imipramine to determine the antidepressant of choice for manic-depressive illness.