The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo
Abstract
One hundred and fifteen patients from 5 general practices participated in a 12-week, double-blind study comparing L-tryptophan, amitriptyline, L-tryptophan-amitriptyline combination and placebo in the treatment of depression. Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo. Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups. Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active treatment groups, but this difference was not significant. Plasma amitriptyline and nortriptyline levels were similar in the amitriptyline and combined treatment groups. Standard haematological and biochemical profiles did not alter significantly in any group, but mean heart rate was significantly increased in patients receiving amitriptyline. There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms.
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Compliance with antidepressant treatment is often poor: between 20% and 59% of patients in primary care stop taking antidepressants within three weeks of the drugs being prescribed.
“Compliance with antidepressant treatment is often poor: studies have shown that between 20% and 59% of patients in primary care stop taking antidepressants within three weeks of the drugs being prescribed. 1 2”
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- Authors
- Thomson, J., Rankin, H., Ashcroft, G. W., Yates, C. M., McQueen, J. K., & Cummings, S. W.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 1982-11
- Volume
- 12
- Issue
- 4
- Pages
- 741-751
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2147391344
- Cited by
- 177
- References
- 1
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 8 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 4
- FWCI
- 3.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Keywords
- depression, tryptophan, amitriptyline, combination therapy, placebo comparison, general practice, antidepressant efficacy, adverse effects, plasma tryptophan, nortriptyline, heart rate, Hamilton Depression Rating Scale
- MeSH terms
- Adolescent, Adult, Aged, Amitriptyline, Depressive Disorder, Drug Therapy, Combination, Family Practice, Female, Humans, Male, Middle Aged, Nortriptyline, Tryptophan
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