Psychological Medicine

Research Article

An evaluation of continuation therapy with tricyclic antidepressants in depressive illness1

R. H. S. Mindhama1, C. Howlanda2 and Michael Shepherda3 p1

a1 From the Institute of Psychiatry, London

a2 Medical Research Council Statistical Research and Services Unit, London

a3 University College Hospital Medical School, London


A double-blind clinical trial has been carried out to ascertain whether patients making a good recovery from depressive illness with tricyclic antidepressant medication derive any benefit from continuation of therapy with the same drug at a lower dose level. Of the 92 patients who entered the trial significantly fewer on active treatment relapsed during the six-month trial period: 22% as compared with 50% of patients receiving placebo. Patients with residual symptoms on entry to the trial derived more benefit from continuation therapy than patients who had made a complete recovery. The findings relate to a six-month trial period only, and any possible advantage of continuation therapy over a longer period remains uncertain.


p1 Requests for reprints should be addressed to M.S.


1 Report to the Medical Research Council Committee on Clinical Trials in Psychiatry. Members of the Committee: Professor Sir Austin Bradford Hill (Chairman), Dr. R. H. Cawley, Professor M. G. Gelder, Professor D. A. Pond, Professor W. Linford Rees, Professor T. Ferguson Rodger, Professor Sir Martin Roth, Professor Michael Shepherd, Dr. I. Sutherland, Dr. M. H. Lader (Secretary).

The trial was undertaken in eight main centres (see below) and was coordinated by Dr. R. H. S. Mindham.

Regional organizers—Cardiff: Dr. A. C. Brown. Chichester: Dr. A. I. M. Glen, Dr. D. W. Pierce. Edinburgh: Dr. N. B. Kreitman. Glasgow: Dr. R. N. Herrington. London: Dr. R. H. Cawley, Dr. R. H. S. Mindham. Newcastle: Professor J. L. Gibbons. Oxford: Dr. P. J. V. Beumont. Sheffield: Professor F. A. Jenner, Dr. I. B. Pearson.

The following psychiatrists participated in the trial—Cardiff: Dr. I. G. Pryce. Chichester and region: Dr. J. D. Morrissey, Dr. P. Sainsbury, Dr. J. P. Scrivener, Dr. D. W. Pierce. Edinburgh and region: Dr. J. W. Affleck, Dr. J. R. Smythies. Glasgow and region: Dr. A. Bruce, Dr. R. N. Herrington, Dr. P. W. Kershaw. London and region: Dr. R. H. Cawley, Dr. J. J. Cockburn Dr. J. L. Crammer, Dr. J. P. Dewsbery, Dr. Brenda Grant, Dr. K. Hamadah, Dr. E. A. Harvey-Smith, Dr. S. Jacobson, Dr. J. P. Leff, Dr. W. A. Lishman, Dr. C. McDonald, Dr. F. Post, Dr. E. Roderick-Evans, Dr. G. K. Shaw, Dr. D. C. Watt, Dr. R. H. Wheeler, Dr. J. W. P. Willis. Newcastle and region: Dr. K. Davison, Professor J. L. Gibbons, Dr. H. A. McClelland, Dr. D. D. Webster. Oxford region: Dr. P. J. V. Beumont. Sheffield and region: Dr. E. B. Gordon, Dr. E. Howarth.