Citation

Fountoulakis KN, Iacovides A, St Kaprinis G. Can. J. Psychiatry 2004; 49(1): 73-74.

Copyright

(Copyright © 2004, Canadian Psychiatric Association, Publisher SAGE Publications)

DOI

10.1177/070674370404900120

PMID

unavailable

Abstract

AuthorsConclusions:Our report is the first one on the combined use of oral venlafaxine and Anafranil infusions. The only prior combined treatment reported concerns maprotiline. The usual practice of infusions suggests starting with one-half ampoule of clomipramine and adding 1 ampoule every ay to reach a maximum of 5 to 6 ampoules. Anecdotal data report higher dosages of 8 to 9 ampoules daily.; FreeText:The patient began to experience free-floating anxiety and incomplete panic attacks at age 26 years, which were soon followed by major depression. Two years later, at age 28 years, she presented to the outpatient clinic. She had already attempted suicide once by swallowing pills a couple of months prior to presenting. The patient received the following adequate but unsuccessful treatment trials (including combinations) lasting at least 4 months each: 60 mg fluoxetine, 375 mg venlafaxine, 40 mg haloperidol, 6 mg risperidone, lithium (plasma levels 1.0 mEq/L), carbamazepine (plasma levels 9 mcg/mL. She also had 8 Anafranil infusions (maximum 4 ampoules). She refused electroconvulsive therapy (ECT). During the last year, she had rare mood-congruent auditory hallucinations. A more aggressive treatment with high dosages of iv Anafranil plus oral 225 mg venlafaxine was tried. Given 1 mg dexamethasone, she was a nonsuppressor on the dexamethsone suppression test (DST) (based on the cut-off point of 5 mcg/dl plasma cortisol) and had blunted response to 30 mg dexfenfluramine challenge test (cut-off 50 mcU/L prolactin). Brain imaging single photon emission computed tomography (SPECT) showed increased regional cerebral blood flow in the frontal lobes (+ 1.5 sd) and reduced regional cerebral blood flow (-0.30 to -1.4 sd) in the rest of brain areas. The patient received the following adequate but unsuccessful treatment trials (including combinations) lasting at least 4 months each: 60 mg fluoxetine, 375 mg venlafaxine, 40 mg haloperidol, 6 mg risperidone, lithium (plasma levels 1.0 mEq/L), carbamazepine (plasma levels 9 mcg/mL. She also had 8 Anafranil infusions (maximum 4 ampoules). She refused electroconvulsive therapy (ECT). During the last year, she had rare mood-congruent auditory hallucinations. A more aggressive treatment with high dosages of iv Anafranil plus oral 225 mg venlafaxine was tried.; Indications:1 patient with major depression. Coexisting diseases include dependent and borderline personality disorder; Patients:One 33 year old married woman.; TypeofStudy:A case report of a patient with treatment-refractory dependent and borderline personality and major depression with atypical features diagnosed according to DSM-IV criteria and treated successfully with combined oral venlafaxine and intravenous Anafranil.; DosageDuration:Initially 8 iv infusions (maximum 4 ampoules) increased to maximum dosage of 6 ampoules. Duration not stated.; Results:The result of initial Anafranil therapy resulted with only partial and unstable response for a couple of days. On day 15 after the second trial of Anafranil, the patient responded with a dramatic remission of symptoms, almost to normothymic state. Her overall Hamilton Depression Rating Scale (HDRS) score decreased from 37 to 11, and her Hamilton Anxiety rating Scale score decreased from 46 to 22. On the following HDRS indexes, her scores were as follows: depression symptoms decreased from 8 to 6; insomnia symptoms decreased from 6 to 3 and nonspecific symptoms decreased from 5 to 0. This remission lasted for 37 days; then, obeying auditory hallucinations, the patient unsuccessfully attempted suicide by swallowing 30 tablets of diazepam 10 mg and thioridazine 30 mg. The mood change was acute, occurring within a few hours.; AdverseEffects:No adverse events were mentioned.

Language: en

Keywords

adult; human; female; case report; anxiety; major depression; lithium; treatment outcome; symptomatology; treatment planning; clinical feature; clomipramine; fluoxetine; venlafaxine; letter; disease course; haloperidol; borderline state; carbamazepine; risperidone; dose response