A stimulating, mood-elevating drug used primarily in combating depressions.Two types of energizers, or “psychoanaleptics,” are in use today: MAO inhibitors, which have a largely indirect stimulating effect by suppressing the action of the enzyme monoamine oxidase; and non-MAO inhibitors, which appear to have a more direct effect on the central nervous system. Both have the advantage of long-term action with minimal side effects, in contrast to such stimulants as amphetamines (Benzedrine, Dexedrine, Desoxyn), which have only transient effects and produce anorexia (loss of appetite) and insomnia.MAO inhabitors are the outgrowth of experiments with iproniazid (Marsilid) in the treatment of tuberculosis. This drug was found to have a euphoric effect on patients, making them gay, optimistic and lively. As a result, Nathan S. Kline tried the drug on depressive patients and found it effective. Unfortunately it had dangerous side effects—particularly toxic hepatitis—but within a short time several chemical analogues were developed with similar antidepressant properties but which could be administered with safety. The most widely used are isocarboxazid (Marplan), phenelzine (Nardil) and the somewhat less effective nialamide (Niamid).These drugs have relatively mild and readily controlled side effects, such as constipation, insomnia, headache, tremors, dry mouth, lowered blood pressure, and, if given in large doses, hypomanic (excited) states. Frequently a tranquilizer is given along with the antidepressant to prevent excitement and overactivity. Good to excellent results have been achieved within a few days in 70 to 90 per cent of depressions of both the neurotic and psychotic types. Preliminary studies have indicated that a newer MAO inhibitor, MO-109, is also effective with schizo-affective patients who manifest autism and flatness of affect as well as depression.Several non-MAO inhibitors are also in wide use. Imipramine (Tofranil), introduced in 1957, has proved effective in 70 to 80 per cent of clear-cut depressions, particularly of the retarded type. It is less effective with agitated depressions, though it may be combined with a tranquilizer of the phe- nothiazine type in these cases. It has limited use in depressions complicated by schizophrenic or organic brain disorder, and in neurotic depressions and hypochondriacal states. Similar results are achieved with amitriptyline, marketed as Elavil, but sometimes one of these drugs works when the other does not. Side effects are slight with both drugs; the most common are dry mouth, perspiration, difficulty in focusing the eyes, and insomnia when first given. Two related drugs are desmethyl- imipramine (Pertofrane) and desmethyl- amitriptyline (Nortriptyline). Another important drug of the non-MAO group is chlorprothixene (Taractan), which has both tranquilizing and alerting effects.In addition to these drugs, there are a number of minor antidepressants rarely prescribed for severe depressions. Small doses of amphetamines are occasionally used as mood-elevators, since these drugs can help in overcoming mild depression and apathy, and in restoring self-confidence. Continuous use, however, may result in addiction, and large amounts may produce weakness, depression, gastrointestinal disturbances, tremors and in some cases symptomatic psychoses. Combination drugs, such as the stimulant dextroamphetamine plus the sedative amobarbital (Dexamyl) are also used in combating depression. Other psychomotor stimulants used for mild depressions are methylphenidate (Ritalin), pipradol (Meratran), and deanol (Deaner). Like the amphetamines, they are more often prescribed for fatigue and for maintaining wakefulness in extreme situations, and are also recommended in organic cases of narcolepsy. The tranquilizer chlordiazepox- ide (Librium) may also be prescribed for mild depressions accompanied by marked anxiety.Finally, there is a “bimodal” group of drugs, combining amphetamine-like stimulation of the central nervous system with a slower-acting effect resulting from the inhibition of monoamine oxidase. Among them are tranylcypromine (Parnate), etryptamine (Monase), and pargyline (Eutonyl). These drugs produce the rapid but sustained action needed in cases of non-agitated neurotic and psychotic depression as well as depressed forms of schizophrenia. They are safe with respect to the liver but may have side effects such as overstimulation, insomnia, headache, and lowered blood pressure.Antidepressant drugs have not replaced electroshock therapy in the treatment of severe depressions, but they have reduced the need for it, particularly when the threat of suicide is not acute and improvement can be somewhat delayed. After initial improvement, patients are usually kept on maintenance doses for several weeks, and the medication is then gradually withdrawn. For energizers combined with tranquilizers,
