Amitriptyline in depressive states

Abstract

Since its introduction in 1938, electroconvulsive therapy (E.C.T.) has shown itself to be a dramatically effective, unusually safe treatment for severe depressive states (“melancholias”, “endogenous” or “psychotic” depressions). Nevertheless, it is repugnant to many patients and psychiatrists, produces a troublesome, if transient, amnesia—especially in older individuals—and is occasionally complicated by fractures and dislocations as well as by anaesthetic and relaxant misadventures. Worst of all, as early studies showed, of the 80–90 per cent. of severe depressives who respond to E.C.T., some 30 per cent. relapse (Huston and Locher, 1948 a, b). Recent work suggests that the rate of relapse may often be higher still—thus of 94 per cent. of a group of patients who had responded to E.C.T., Kiloh and Ball (1961) reported that 46 per cent. had relapsed during the six months following the cessation of treatment. For these reasons, the trend to chemotherapy initiated by the advent of effective antidepressant compounds in 1957 continues to develop, and signs are becoming manifest that within a few years E.C.T. may be replaced by pharmacotherapy.