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Behavioral Disturbances During Their Administration to Depressed Patients

David Pickar, MD; Dennis L. Murphy, MD; Robert M. Cohen, MD, PhD; Iain C. Campbell, PhD; Steven Lipper, MD, PhD

Arch Gen Psychiatry. 1982;39(5):535-540.

Abstract
• The occurrence of behavioral disturbances during fourweek treatment of depressed patients with the nonselective monoamine oxidase (MAO) inhibitor, phenelzine sulfate (N = 14), the selective MAO-type A inhibitor, clorgyline (N = 12), and the partially selective MAO-type B inhibitor, pargyline hydrochloride (N = 13), was studied. Behavioral disturbances were encountered during treatment with each of the MAO-inhibiting drugs, with an overall incidence of 15% (six of 39 patients). All but one episode met criteria for mania or hypomania. Patients with bipolar illness experienced significantly greater incidences of behavioral disturbances in comparison with patients with unipolar illness (35.3% v 4.5%, respectively). The earliest latency to onset of a behavioral disturbance was 18 days, whereas the mean latencies were 22 to 26 days. Episodes of hypomania were observed after discontinuation of drug treatment in individual patients with unipolar and bipolar illness. Repeated MAO-inhibitor treatment, as part of a crossover study of clorgyline and pargyline, produced an increased severity of behavioral disturbances and a significantly shortened latency to onset.

Author Affiliations
From the Neuroscience (Dr Pickar) and Clinical Neuropharmacology (Drs Murphy and Cohen) Branches, National Institute of Mental Health, Bethesda, Md, the Institute of Psychiatry, Maudsley Hospital, London (Dr Campbell), and the Department of Psychiatry, University of Michigan, Ann Arbor (Dr Lipper).

Footnotes
Accepted for publication Aug 28, 1981.

Reprint requests to National Institutes of Health, Bldg 10, Room 4N214, Bethesda, MD 20205 (Dr Pickar).

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