Revisado por Isabelle Baião de Mello Neto (CRF-MG 24309)Como a substância de Depramina age?
Eficácia de Depramina
A eficácia do Cloridrato de Imipramina contra depressão é comprovada, sendo útil também em outros transtornos psiquiátricos (1).
Pacientes com depressão adequadamente tratados têm cerca de 90% de chance de remissão (3).
Estudos demonstram eficácia comparável a outros antidepressivos em doses de pelo menos 100mg (4-15).
Tricíclicos e ISRS apresentam taxa de resposta similar (cerca de 70%) (1,18).
Ensaios comparativos mostram resultados equivalentes entre Imipramina e outros antidepressivos (4,7-14).
Metanálise confirma eficácia em doses equivalentes a 100-200mg de Imipramina (2).
Eficaz na prevenção de recaídas após eletroconvulsoterapia (16-19) e no tratamento de dor neuropática (20,21).
Comprovado efeito contra enurese noturna infantil (22-26).
Referências Bibliográficas:
1. Baldessarini RJ. Drugs and the treatment of psychiatric disorders. Depression and anxiety disorders. In: Goodman & Gilman. The pharmacological basis of therapeutics. 10th edition. Hardman JG, Limbird LE, editors. McGraw-Hill 2001. Pages 456-459.
2. Bollini P, Pampallona S, Tibaldi G, Kupelnick B, Munizza C. Effectiveness of antidepressants. Meta-analysis of dose-effect relationships in randomised clinical trials. British Journal of Psychiatry 1999; 174:297-303.
3. Quitkin FM, McGranth PJ, Stewart JW, Deliyannides D, Taylor BP, Davies CA, Klein DF. Remission rates with 3 consecutive antidepressant trials: Effectiveness for depressed outpatients. J Clin Psychiatry 2005; 66:670-676.
4. Keller MB, Gelenberg AJ, Hirschfield MA, Rush AJ, Thase ME, Kocsis JH, et al. A doubleblind, randomized trial of sertraline and imipramine. J Clin Psychiatry 1998; 59:598-607.
5. Miller IW, Keitner GI, Schatzberg AF, Klein DN, Thase ME, Rush AJ, et al. Psychosocial before and after treatment with sertraline or imipramine. J Clin Psychiatry 1998;59:608-619.
6. Rush AJ, Koran LM, Keller MB, Markowitz JC, Harrison WM, Miceli RJ, et a. Study and rationale for evaluating the comparative efficacy of sertraline and imipramine as acute, crossover, continuation, and maintenance phase therapies. J Clin Psychiatry 1998; 59:589- 597.
7. Lepola U, Arató M, Zhu Y, Austin C. Sertraline versus imipramine treatment of comorbid panic disorder and mayor depressive disorder. J Clin Psychiatry 2003;64:654-662.
8. Thase ME, Rush AJ, Howland RH, Korstein SG, Kocsis JH, Gelember AJ, et al. Doubleblind switch study of imipramine or sertaline treatment of antidepressant-resistant chronic. Arch Gen Psychiatry 2002; 59:233-29.
9. Rusell JM, Koran LM, Rush J, Hirschfeld MA, Harrison W, Friedman ES, et al. Effect of concurrent anxiety on response to sertraline and imipramine in patients with chronic depression. Depression and Anxiety 2001; 13:18-27.
10. McGrath PJ, Stewart JW, Janal MN, Petkova E, Quitkin FM, Klein DF. A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of atypical depression. Am J Psychiatry 2000;157:344-350.
11. Simon GE, Heiligenstein J, Revicki D,Vonkonff M, Katon WJ, Ludman E, Grothaus L, Wagner E. Long-term outcomes of initial antidepressant drug choice in a “Real World” randomized trial. Arch Far Med 1999; 8:319-325.
12. Nemeroff CB. Evans DL, Gyulai L, Sachs GS, Bowden CL, Gergel IP, Oakes R, Pitts CD. Double-blind, placebo-controlled comparison of impramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry 2001; 158:906-912.
13. Birkenhager TK, van der Broek WW, Mulder PG, Brujin JA, Moleman P. Comparison of two-phase treatment with imipramine or fluvoxamine, both followed by lithium addition, in inpatients with major depressive disorder. Am J Psychiatry 2004; 161:2060-2065.
14. Van Amerongen AP, Ferry G, Tournoux A. A randomised, double-blind comparison of minacipran and imipramine in the treatment of depression. J Affect Disord. 2002; 72(1):21- 31.
15. Silverstone T. Moclobemide vs. Imipramine in bipolar depression: a multicentre doubleblind clinical trial. Acta Psychiatr Scand. 2001; 104(2): 104-9.
16. Barlow DH, Gorman JM, Shear MK, Woods SW; Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder - A Randomized Controlled Trial; JAMA; May; 283(19); 2000; 2529-2450
17. Mavissakalian MR, Perel JM, Talbott-Green M, Sloan C; Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia; Biol Psychiatry; Jun; 43(11); 1998; 848-854
18. Mavissakalian MR; Imiprmaine vs. Sertraline in Panic Disorder: 24-Week Treatment Completers; Annals of Clinical Psychiatry; Vol. 25(3/4); Sept/Dec; 2003; 171-180
19. Stein MB, Goin MK, Pollack MH, et al.; Practice Guideline for the treatment of patients with panic disorder: Second edition. Am J Psychiatry; 2009; 166 (2):1
20. Saarto, T., Wiffen, P.J.; Antidepressants for neuropathic pain (Review); Cochrane Collaboration; A Cochrane Review. Cochrane Library, Iohn Wiley & Sons, Ltd; (3); 2009
21. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T; European Federation of Neurological Societies; EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision; Eur J Neurol.; Sep;17(9); 2010; 1113-e88
22. Kardash S, Hillman ES, Werry J. Efficacy of imipramine in childhood enuresis: a doubleblind control study with placebo. Can Med Assoc J. 1968 Aug 10; 99(6):263-6.
23. Fritz GK, Rockney RM, Yeung AS. Plasma levels and efficacy of imipramine treatment for enuresis. J Am Acad Child Adolesc Psychiatry. 1994 Jan;33(1):60-4.
24. Monda JM, Husmann DA. Primary nocturnal enuresis: a comparison among observation, imipramine, desmopressin acetate and bed-wetting alarm systems. J Urol. 1995 Aug;154(2 Pt 2):745-8.
25. Smellie JM, McGrigor VS, Meadow SR, Rose SJ, Douglas MF. Nocturnal enuresis: a placebo controlled trial of two antidepressant drugs. Arch Dis Child. 1996 Jul;75(1):62-6.
26. Nevéus T, Tullus K. Tolterodine and imipramine in refractory enuresis; a placebo-controlled crossover study. Pediatr Nephrol. 2008 Feb;23(2):263-7.
Como Depramina age no organismo?
Como Depramina age no corpo?
Tipo de medicamento
Antidepressivo tricíclico. Aumenta a concentração de neurotransmissores no cérebro.
Como Depramina age?
Inibe a recaptação de noradrenalina e serotonina, principais responsáveis pelo efeito antidepressivo.
O que acontece com Depramina no corpo?
Como Depramina é absorvida?
Absorção rápida pelo trato gastrointestinal. Concentração máxima em 1,75-5 horas.
Como Depramina se distribui?
Ligação a proteínas plasmáticas: 60-96%. Atravessa leite materno.
Como Depramina é metabolizada?
Transformada no fígado em desipramina (metabólito ativo).
Como Depramina é eliminada?
Meia-vida: 19 horas. Excretada principalmente pela urina (80%).
Efeitos em grupos especiais
Idade do paciente
Crianças: metabolismo similar a adultos. Idosos: maior concentração plasmática.
Problemas nos rins
Monitorar em insuficiência renal moderada/grave.
Problemas no fígado
Monitorar em insuficiência hepática.
Diferenças étnicas
Metabolismo varia conforme fatores genéticos.
Estudos em animais
Sem evidência de potencial carcinogênico ou teratogênico relevante.