Maprotiline chemical structure of maprotiline
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Pharmacology

Maprotiline (sold as Deprilept®, Ludiomil®, Psymion®) is a tetracyclic antidepressant. It is a stong norepinephrine reuptake inhibitor with only weak effects on serotonin and dopamine reuptake.

It exerts blocking effects at the following postsynaptic receptors:

  • Strong : alpha1
  • Moderate : 5-HT2, muscarinic, H1, D2
  • Weak : alpha2
  • Extremely weak : 5-HT1

The pharmacologic profile of Maprotiline explains its antidepressant, sedative, anxiolytic, sympatholytic, and anticholinergic activities. Additionally, it shows a strong antagonism against Reserpine-induced effects in animal studies, as the other 'cassical' antidepressants do. Although Maprotiline behaves in most regards as a 'first generation antidepressant' it is commonly referred to as 'second generation antidepressant'.

Sedation has a fast onset (the same day), while remission of the depression itself is noted usually after a latent period of 1 to 4 weeks.

Maprotiline does not brighten up the mood in nondepressed persons.

History

Maprotiline was developed and has been marketed by the Swiss manufacturer Geigy (now Novartis) since the early 1980's under the brand name Ludiomil®. Generics are widely available.

Indications

  • Treatment of depressions of all forms and severities (endogenous, psychotic, involutional, and neurotic)
  • Treatment of the depressive phase in bipolar depression
  • For the symptomatic relief of anxiety, tension or insomnia

N.B. The use of Maprotiline in the treatment of Enuresia in pediatric patients has so far not been systemetically explored and its use can therefore not be recommended.

Contraindications

Absolute

  • Hypersensitivity to Maprotiline or to other tri-/tetracyclic antidepressants
  • Hypertrophy of the prostate gland with urine hesitancy
  • Closed Angle Glaucoma

Special caution needed

  • Concomitant treatment with a MAO-Inhibitor
  • Serious impairment of liver and kidney function
  • Epilepsy and other conditions that lower the seizure threshold (active brain tumors, alcohol withdrawal, other medications)
  • Serious cardiovascular conditions (arrhythmias, heart insufficience, state after myocardial infarction etc.)
  • Treatment of patients under age 18

Pregnancy and nursing

If you are pregnant or thinking of becoming pregnant, before taking this medicine talk to your doctor about the benefits versus the risks to your pregnancy. Animal studies showed delayed bone development. Use this medicine only if it is clearly needed.

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Music therapy in the treatment of adults with mental disorders
From Journal of Music Therapy, 4/1/03 by Hadsell, Nancy A

Unkefer, R. F., & Thaut, M. H. (Eds.) (2002). Music therapy in the treatment of adults with mental disorders (2nd ed). St. Louis: MMB Music, Inc.

The purposes of the second edition of this book are to update information from the previous version and to create a more readable textbook for instructional programs in music therapy. The authors and editors have achieved these broad goals exquisitely in this long-awaited revision of a classic text in the field.

The format of the book and its division into four sections remains the same. However, the content has remarkable changes which greatly enhance the readability of the text. Section One, which includes five chapters outlining the theoretical bases for music in therapy with specific emphasis on music as therapy with clients exhibiting psychiatric disorders, has been dramatically improved. Not only does the research presented cover the most recent works available, but its presentation allows the reader to understand its relevance to music therapy theory and practice much more clearly than was the case in the first edition. These five chapters, with very few modifications, could stand alone as a text on the theoretical bases for the uses of music in therapy, in general, though, they do address specific applications of the information presented in mental health more thoroughly than in the first edition.

Section Two also includes five chapters. Chapter Six is completely new in this text and outlines Thaut's Cognition-Affect Model for Neuropsychiatric Music Therapy. The author presents this model in three sections. In the first, he cites relevant research which gives rise to his thinking; in the second he describes properties of music which make it conducive to influencing behavioral/affective changes (i.e., psychophysical, collative, and ecological); and finally, he outlines clinical applications based on the information presented. This chapter is a welcome addition to the work, as it provides a coherent bridge between the theoretical and research ideas of section one and the clinical applications discussed in section two. Chapters Eight (covering music therapy within the context of psychotherapeutic models) and Nine (detailing the most recent information on psychopharmacology and its implications for music therapy practice) retain the same formats as in the first edition but add recent changes in emphasis and information. Unfortunately, the psychopharmacology chapter contains a few errors (e.g., the misspelling of the brand name drugs, Klonopin and Asendin, and the incorrect time frame for the appearance of the tetracyclic antidepressants, Ludiomil and Asendin, which have been on the scene at least since the mid-80s). In response to a recent query regarding this chapter, the publisher has indicated that an errata sheet will be added to correct any minor errors, thus assuring that the reader has correct, up-to-date information on this topic.

Sections Three (the Taxonomy of Clinical Music Therapy Programs) and Four (the tables of clinical music therapy interventions grouped by diagnosis and client characteristics) remain largely unchanged from the first edition. They serve not only as educational materials for the music therapy student/intern but also as references for the seasoned therapist seeking to broaden the clinical interventions available to their clients.

The second edition of this classic music therapy text has achieved its purposes well. The authors have updated their information, improved their presentation, and succeeded in providing their readers with detailed research, theory, and clinical interventions which are immediately applicable to music therapists, not only in psychiatric settings, but in many others as well. Because so much excellent research and theory underlying the practice of music therapy are included, it is somewhat unfortunate that the title of this important work, which emphasizes music therapy treatment for adults with mental disorders, could potentially narrow its readership to those only interested in this aspect of the field. In fact, this book is an important addition to the library of all music therapists, not simply those working in the area of psychiatry/mental health. Finally, it also serves as a lasting tribute to its recently deceased first editor, Robert Unkefer.

NANCY A. HADSELL

Texas Woman's University

Copyright American Music Therapy Association Spring 2003
Provided by ProQuest Information and Learning Company. All rights Reserved

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