Heinz E. Lehmann, M. Berthiaume and Thomas A. Ban: Trimipramine A New Antidepressant (1964)

H.E. LEHMANN, M. BERTHIAUME AND T.A. BAN, editors:
TRIMIPRAMINE: A NEW ANTI-DEPRESSANT

Montreal: Quebec Psychopharmacological Research Association; 1964 (105 pages).
Reviewed by Thomas A. Ban

INFORMATION ON CONTENTS: Trimipramine was synthesized, in 1956 by Jacob and Messer with the hope that it will combine the effect of imipramine on dysthymic mood and psychomotor inhibition with those of levomeprazine on states of anxiety and sleep disturbances. The synthesis resulted in trimipramine, a substance that differed pharmacologically from imipramine in that it reduced epinephrine-induced hypertension while increasing the hypertensive effect of norepinephrine. The psyhotropic properties of the substance were recognized and first evaluated in France, where the preclinical and clinical aspects of the drug were studied by Julou, Dutertre, Lambert, Sigwal, Vidal, Géraud, Millon and Pommé.

The material in this book is divided into two parts (Basic Science Session and Clinical Session), preceded by a Preface and followed by a Bibliography of publications on the drug. The Basic Science Session opens with Heinz E. Lehmann’s “Introduction”, in which he notes that the “issue of antipsychotic versus antidepressant pharmacotherapy has recently (1964) come under scrutiny” because there are psychotic non-depressed patients who improve when they receive antidepressant medication, and there is a certain proportion of depressed patients` who benefit from antipsychotic medication. He also expressed concerns about the lack of indicators for identifying those patients who will derive the greatest benefit from a particular psychoactive drug. Lehmann concludes his introduction as follows: “A more sophisticated diagnostic classification of our psychiatric patients has become an urgent requirement if we want to become closer to the ideal of good physicians who treat their patients as individuals and not statistical probabilities.” From the five papers that follow, in the first, the pharmacology of trimipramine is reviewed by Aurèle Beaulnes; in the second, the “Effects of trimipramine on capillary permeability alterations induced by dextran in the rat” are  presented by L. Kato, B.Gozsy, M. Lemieux and A. St.Jean; in the third, the effects of the substance on the human electroencephalogram are discussed by Maurice Coulombe; in the fourth,   the effects of trimipramine, levomepromazine and chlorpromazine on a battery of “psychophysical test performance” are  compared by A. St.Jean, T.A. Ban and W. Noe; and in the fifth, the differential effects of trimipramine and chlorpromazine on spider web formation are described by G. Groh and M. Lemieux.

The Clinical Session opens with Pal Rajotte’s Introduction, in which he emphasizes the importance of establishing clearly the effectiveness of potential new antidepressants, in view of the experience that some of these drugs in clinical investigation had failed to fulfill expectations in terms of therapeutic effects. From the eight papers that follow, in two, one conducted by R. Legault and the other by R. Côté, the effects of trimipramine are described in 81 and 19 patient with anxiety and depression, respectively; and in another two, one conducted by Y Rouleau, and the other conducted by I. Erutku, T.A. Ban and H.E. Lehmann, the effects of the substance are discussed in 100 and 20 newly admitted depressed patients, respectively. In one paper, findings in two studies, both conducted in geriatric patients by   H.E. Lehmann, V.A. Kral, T.A. Ban, H. Ast, C. Barriga and A Lidsky, are presented. From these two studies in one, the substance was used as add on medication in 10 patients, whereas in the other, a placebo-controlled study, the substance was used in 12 patients as sole medication. Finally, in two studies, one conducted by A. Scarlatesco, W. Jacob and L. Kelen in 129 patients, and the other by W Jacob in 102 patients, the effects of the substance were described in general practice.

The book concludes with a chapter by Thomas A. Ban on “Trimipramine in psychiatry,“ in which the history of trimipramine is briefly reviewed and the findings presented in the Basic and Clinical Sessions in this volume  are integrated with the published literature.

EDITOR’S STATEMENT: Trimipramine: A New Anti-Depressant is based on the proceedings of the first North American Colloquium on Trimipramine, organized by the Quebec Psychopharmacological Research Association (QPRA) at St. Jean–de-Dieu Hospital, in Montreal-Gamelin, Quebec, Canada, on May 28, 1964. This was the second meeting of the QPRA. The first, held in January 1964, attempted to place   a new group of drugs with anti-psychotic properties, the butyrophenones, in the proper place in the therapeutic arsenal of psychiatry. The goal of the second meeting was to introduce trimipramine, a substance already in clinical use in the treatment of depression in Europe at the time, in North America. 

Thomas A. Ban

June 26, 2014