dothiepin-hydrochloride and Bipolar-Disorder

Tricyclic antidepressant drugs dosulepine (TCA), serotonin selective reuptake inhibitor (SSRI) and prophylactic agent with antidepressant effect lithium carbonicum (Li) have different cardiovascular side-effects. We compared them in the prophylactic therapy of periodic affective disorder in remission with TCA, SSRI and Li. Our previous papers confirmed the most prominent effects of heart electric field parameters in TCA patients (Slavícek et al., 1998). In the present work we studied for the first time the dose-dependent changes of ECG, body surface potential maps (BSPM - parameter DIAM 30, 40) in 43 TCA dosulepine, 40 SSRI citalopram and 30 Li outpatients (Hamilton scale: HAMDŁ10; age 40+/-5 years; treated for depressive disorders or bipolar disorders). The daily doses of dosulepine were 50-250 mg, citalopram 20-80 mg, Li plasma levels 0.66+/-0.08 meq/l. The electrocardiogram (ECG), vectorcardiogram (VCG), and BSPM were measured and calculated by the Cardiag 112.1 diagnostic system. The results have shown a relation between the dose of dosulepine and extremum (maximum and minimum) of depolarization isoarea map in dosulepine, but not in citalopram patients. The repolarization BSPM changes were most pronounced in SSRI patients. Lithium in long-term prophylaxy (1-22 years) caused only minimal ECG BSPM changes. The present results correspond with our previous observations.

Topics: Adult; Analysis of Variance; Antidepressive Agents; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Bipolar Disorder; Body Surface Potential Mapping; Cardiovascular Physiological Phenomena; Citalopram; Data Interpretation, Statistical; Depressive Disorder; Dose-Response Relationship, Drug; Dothiepin; Electrocardiography; Heart Rate; Humans; Lithium Carbonate; Middle Aged; Statistics, Nonparametric; Vectorcardiography

Antidepressant-induced switch to mania has not been thoroughly characterized in bipolar disorder and is even less well understood in unipolar depression.. I describe, as a first-person narrative, my own experience of psychotic mania, which was suspected to have been induced by the tricyclic antidepressant, dosulepin. I have had a 16-year history of depression and was receiving sertraline 50 mg od when I was prescribed, off licence, dosulepin 25 mg 1-2 nocte for insomnia. Within days, I developed mild hypomanic symptoms and returned to my GP, who discontinued dosulepin but continued treatment with sertraline. I was also referred for psychiatric assessment. Two months later, I was detained under Section II of the Mental Health Act 1983 and admitted to hospital with psychotic manic symptoms.. More understanding of antidepressant-induced switch to mania is needed in unipolar depression. My case study highlights the need for prompt specialist care for patients with depression reporting even mild, sub-threshold symptoms of mania.

Topics: Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Azabicyclo Compounds; Bipolar Disorder; Commitment of Mentally Ill; Dothiepin; Drug Therapy, Combination; Female; Humans; Hypnotics and Sedatives; Mental Recall; Piperazines; Psychoses, Substance-Induced; Sertraline

Tricyclic antidepressants sometimes trigger mania in bipolar patients, but little is known about their potential for abuse in this regard.. We describe a man with bipolar disorder and alcohol dependency who abused dosulepin repeatedly in order to induce manic episodes. This caused serious problems for treatment and long-term outcome. We mention two further cases in which dosulepin or clomipramine was used deliberately to induce bipolar mania.. Tricyclic antidepressants can be abused to induce mood elevation in bipolar patients. This should be considered in cases of treatment-resistant mania.

Topics: Adult; Alcoholism; Antidepressive Agents, Tricyclic; Bipolar Disorder; Dothiepin; Humans; Male; Self Stimulation; Substance-Related Disorders

Topics: Adolescent; Adult; Amitriptyline; Anthracenes; Antidepressive Agents; Azocines; Benzoates; Benzofurans; Bipolar Disorder; Clomipramine; Cyclothymic Disorder; Depression; Dibenzazepines; Dimethylamines; Dothiepin; Humans; Imipramine; Methylamines; Middle Aged; Personality Disorders; Propylamines; Schizophrenia