The effect of different doses of maprotiline on the treatment of Iranian patients suffering from moderate MDD

Introduction: Treatment effect of maprotiline at different doses (50-150 mg/d) as a tetracyclic antidepressant, with major effects on NEP and less anticholinergic side effects compared to some other tricyclic medications, has been compared with other medications. Given ethical and cultural differences as well as pharmacokinetic characteristics between Iranian populations, the current study was carried out to determine the effect of different doses of maprotiline in treatment of moderate MDD, its therapeutic ratio and related side effects in each dose, and also to define the effective dose of maprotiline. Materials and Methods: This quasi-experimental study was performed on the patients with moderate MDD who referred to psychiatry clinics. Thirty cases were selected from the patient with age between 25-50 years, with 20≤ BMI≤30, and without any systemic diseases. Firstly, HAMD-17 test was performed for all subjects and then they took 50mg/d of maprptiline. After two weeks, the subjects were visited again, in case of HAMD-17 < 50%, they received 25mg/d of maprotiline for another two more weeks until their depression was completely treated. Side effects were also checked at two-week intervals. Finally, the number of cured subjects, side effects and effective dose were defined. Results: 27 out of 30 patients were followed up to the end of the study. They included 15 women (55.5%) and 12 men (44.4%) with mean age of 36.2±2.3 years. In dose of 50mg/d , 5 out of 27, in dose of 75 mg/d, 11 out of 22,in dose of 100mg/d, 6 out of 11 ,in dose of 125 mg/d ,3 out of 5 and finally in dose of 150mg/d the remaining 2 patients were cured. With respect to side effects, dry mouth was seen in 8 out of 22 patients received a dose of 75 mg/d and 7 out of 11 patients given a dose of 100mg/d. A significant difference was observed between the mean effective doses in the patients with past history of depression (105 mg/d) in comparison with patients without previous history of Depression (76.5mg/d) (P-value=0.01). The mean effective dose was calculated as 78.03 mg/d. Conclusion: The highest frequency of cure was seen in doses of 75 mg/d and 100mg/d with mean of 78.03 mg/d. Furthermore, the mean effective dose in the patients with a previous history of depression was higher than those without a previous history of depression. In addition, side effects were increased with higher doses of maprotiline. Regarding the restrictions of this study such as the lower number of samples in higher doses, further studies are essential to be conducted in this field.