Mianserin and maprotiline as compared to amitriptyline in severe endogenous depression. A new methodological approach to the clinical evaluation of the efficacy of antidepressants.

Present methodological problems in assessing the clinical efficacy of putative antidepressants require testing of various new strategies. The approach presented by the authors allows "natural" clinical treatments to be evaluated scientifically; double-blind conditions are replaced by other measures of bias control. In this paper, the clinical effectiveness of mianserin in homogenous groups of inpatients with severe endogenous depression is compared with that of maprotiline and amitriptyline. The frequency of change of the respective antidepressant by the physicians in charge as well as patients' self-evaluations based on v. Zerssen's Mood Scale served as outcome criteria. No difference in efficacy was found between maprotiline and amitriptyline, whereas mianserin was significantly less effective. The number of patients complaining of side effects from the two tetracyclic compounds was no less than in the case of amitriptyline. There were, however, qualitative differences; with maprotiline, myoclonic jerks were observed in some cases. The hypothesis that mianserin may possess sedative-anxiolytic rather than antidepressive properties is discussed in conjunction with methodological and theoretical implications.