Editing Maprotiline (section)

==Contraindications==
In generalised theory, maprotiline (as with other tricyclic antidepressants, besides [[trimipramine]]<ref name="pmid8863001">{{cite journal | vauthors = Berger M, Gastpar M | title = Trimipramine: a challenge to current concepts on antidepressives | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 246 | issue = 5 | pages = 235–9 | date = 1996 | pmid = 8863001 | doi = 10.1007/BF02190274 | s2cid = 29596291 | url = }}</ref><ref name="pmid1979173">{{cite journal | vauthors = Eikmeier G, Muszynski K, Berger M, Gastpar M | title = High-dose trimipramine in acute schizophrenia. Preliminary results of an open trial | journal = Pharmacopsychiatry | volume = 23 | issue = 5 | pages = 212–4 | date = September 1990 | pmid = 1979173 | doi = 10.1055/s-2007-1014510 | s2cid = 5719177 | url = }}</ref><ref name="pmid1806621">{{cite journal | vauthors = Eikmeier G, Berger M, Lodemann E, Muszynski K, Kaumeier S, Gastpar M | title = Trimipramine--an atypical neuroleptic? | journal = International Clinical Psychopharmacology | volume = 6 | issue = 3 | pages = 147–53 | date = 1991 | pmid = 1806621 | doi = 10.1097/00004850-199100630-00003 | s2cid = 41564511 | url = }}</ref> and possibly [[clomipramine]]) may somewhat worsen certain features of schizophrenia, necessitating caution in prescribing them to someone with it and continuation of the antipsychotic treatment (e.g., with [[risperidone]] or [[olanzapine]]). However, certain bodies of evidence have found maprotiline a useful augment in treating some of the ''negative'', or "anaesthetic", symptoms of schizophrenia and in probable extension pronounced [[schizoid personality disorder|''schizoidia'']] (including the characteristic deterioration in personal grooming/appearance).<ref name="pmid2570687">{{cite journal | vauthors = Yamagami S, Soejima K | title = Effect of maprotiline combined with conventional neuroleptics against negative symptoms of chronic schizophrenia | journal = Drugs Under Experimental and Clinical Research | volume = 15 | issue = 4 | pages = 171–6 | date = 1989 | pmid = 2570687 | doi = | url = }}</ref><ref name="pmid6105762">{{cite journal | vauthors = Waehrens J, Gerlach J | title = Antidepressant drugs in anergic schizophrenia. A double-blind cross-over study with maprotiline and placebo | journal = Acta Psychiatrica Scandinavica | volume = 61 | issue = 5 | pages = 438–44 | date = May 1980 | pmid = 6105762 | doi = 10.1111/j.1600-0447.1980.tb00882.x | s2cid = 40809634 | url = }}</ref> It has also been weighed against [[fluvoxamine]] in this overall regard (i.e., treating the ''negative symptoms'' of schizophrenia),<ref name="pmid9617979">{{cite journal | vauthors = Silver H, Shmugliakov N | title = Augmentation with fluvoxamine but not maprotiline improves negative symptoms in treated schizophrenia: evidence for a specific serotonergic effect from a double-blind study | journal = Journal of Clinical Psychopharmacology | volume = 18 | issue = 3 | pages = 208–11 | date = June 1998 | pmid = 9617979 | doi = 10.1097/00004714-199806000-00005 | url = }}</ref> with [[fluvoxamine]] evidencing clear superiority therein. Maprotiline, however, may be specifically useful for the "negative symptom" of [[alogia]] (poverty of thought and/or speech) and in this regard was found demonstrably superior to the other control-drugs ([[alprazolam]], [[bromocriptine]], [[citalopram]], [[fluoxetine]], [[fluvoxamine]], [[nortriptyline]]) in one study.<ref name=Shafti2005>{{cite web|url=http://www.psychosocial.com/IJPR_10/Drug_Specific_Responses_Shafti_Rey_Abad.html| vauthors = Shafti SS, Rey A, Abad A |year=2005|title=Drug – Specific Responsiveness of Negative Symptoms.|publisher=International Journal of Psychosocial Rehabilitation|pages=10 (1), 43–51|url-status=dead|archive-url=https://web.archive.org/web/20120712070130/http://www.psychosocial.com/IJPR_10/Drug_Specific_Responses_Shafti_Rey_Abad.html|archive-date=2012-07-12|access-date=2012-04-29}}</ref> [[Citalopram]], [[clomipramine]] and [[fluvoxamine]] appeared particularly useful in the study for reducing ''affective blunting'', with [[alprazolam]] (Xanax) and maprotiline ranking joint-next.

Patients with [[bipolar affective disorder]] should not receive antidepressants whilst in a manic phase (including [[hypomania]]) under any circumstances whatsoever. (By the same analogy, people with [[schizoaffective disorder]], bipolar type should not be taking maprotiline or other antidepressants while manic.) This is because antidepressants are known to come with the risk of worsening acute mania or precipitating it in so vulnerably-predisposed people.<ref name="pmid1528960">{{cite journal | vauthors = Benazzi F, Mazzoli M, Rossi E | title = Severe mania after maprotiline-induced coma | journal = Pharmacopsychiatry | volume = 25 | issue = 4 | pages = 207 | date = July 1992 | pmid = 1528960 | doi = 10.1055/s-2007-1014407 | s2cid = 260253520 | url = }}</ref><ref name="pmid3314536">{{cite journal | vauthors = Wehr TA, Goodwin FK | title = Can antidepressants cause mania and worsen the course of affective illness? | journal = The American Journal of Psychiatry | volume = 144 | issue = 11 | pages = 1403–11 | date = November 1987 | pmid = 3314536 | doi = 10.1176/ajp.144.11.1403 | url = }}</ref>

They ([[antidepressants]]) may also negatively interfere with the treatment of mixed bipolar states (pure or [[schizoaffective disorder|schizo-affective]]), where [[electro-convulsive therapy]]<ref name="pmid28503107">{{cite journal | vauthors = Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M | title = The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features | journal = Current Neuropharmacology | volume = 15 | issue = 3 | pages = 359–371 | date = April 2017 | pmid = 28503107 | pmc = 5405614 | doi = 10.2174/1570159X14666161017233642 | url = }}</ref><ref name="pmid22706421">{{cite journal | vauthors = Kuzman MR, Medved V, Velagic V, Goluza E, Bradas Z | title = The use of electroconvulsive therapy to treat schizoaffective disorder in a patient with pacemaker: a case report | journal = Psychiatria Danubina | volume = 24 | issue = 2 | pages = 211–4 | date = June 2012 | pmid = 22706421 | doi = | url = }}</ref> (generally bilateral), [[sodium valproate|valproate]]<ref name="pmid24359859">{{cite journal | vauthors = Azorin JM, Belzeaux R, Cermolacce M, Kaladjian A, Corréard N, Dassa D, Dubois M, Maurel M, Micoulaud Franchi JA, Pringuey D, Fakra E | title = [Recommendations for the treatment of mixed episodes in current guidelines] | language = French | journal = L'Encephale | volume = 39 | issue = Suppl 3| pages = S185–7 | date = December 2013 | pmid = 24359859 | doi = 10.1016/S0013-7006(13)70120-9 | url = }}</ref> and [[antipsychotics]] prove more beneficial (lithium should not be administered concurrently with [[electro-convulsive therapy|E.C.T.]] treatment, as it may induce severe confusion<ref name="pmid31492631">{{cite journal | vauthors = Patel RS, Bachu A, Youssef NA | title = Combination of lithium and electroconvulsive therapy (ECT) is associated with higher odds of delirium and cognitive problems in a large national sample across the United States | journal = Brain Stimulation | volume = 13 | issue = 1 | pages = 15–19 | date = 2020 | pmid = 31492631 | doi = 10.1016/j.brs.2019.08.012 | s2cid = 201125145 | url = | doi-access = free }}</ref>).<ref name="pmid15898959">{{cite journal | vauthors = Krüger S, Trevor Young L, Bräunig P | title = Pharmacotherapy of bipolar mixed states | journal = Bipolar Disorders | volume = 7 | issue = 3 | pages = 205–15 | date = June 2005 | pmid = 15898959 | doi = 10.1111/j.1399-5618.2005.00197.x | url = }}</ref> However, maprotiline (at a high dose) was put to good use in one particular case, of one young man presenting with what was very-possibly a [[mixed affective state|mixed-manic episode]] with a heavy preponderance of depressive symptoms (appearing as depression with significant [[narcissistic personality disorder|narcissistic]] traits; including ''extrapunitive'' tendencies/blame-shifting, entitlement and interpersonal exploitation; and provisionally considered ''narcissistic depression'').<ref name="pmid23789317">{{cite journal | vauthors = Saito S, Kobayashi T, Kato S | title = [A case of major depressive disorder barely distinguishable from narcissistic personality disorder] | language = Japanese | journal = Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica | volume = 115 | issue = 4 | pages = 363–71 | date = 2013 | pmid = 23789317 | doi = | url = }}</ref> The maprotiline was combined with [[mirtazapine]] (low-dose), [[sodium valproate]] and [[aripiprazole]].

===Absolute===
* Hypersensitivity to maprotiline or to other TCAs and TeCAs
* [[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 tumor]]s, [[alcohol withdrawal]], other medications)
* Serious cardiovascular conditions ([[arrhythmias]], heart insufficiency, state after [[myocardial infarction]] etc.)
* Treatment of patients under age 18<ref>Simeon J, Maguire J, Lawrence S (1981). Maprotiline effects in children with enuresis and behavioural disorders. Progress in Neuro-Psychopharmacology 5 ( 5–6), 495–8</ref>

===Suicidal patients===
As with other antidepressants, maprotiline increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of maprotiline or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Maprotiline is not approved for use in pediatric patients.<ref name=MedlinePlus>U.S. National Library of Medicine. Last Reviewed 1 Sept. 2010 [https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682158.html Medline Plus entry for Maprotiline]</ref>

===Pregnancy and lactation===
Reproduction studies have been performed in female laboratory rabbits, mice, and rats at doses up to 1.3, 7, and 9 times the maximum daily human dose respectively and have revealed no evidence of impaired fertility or harm to the fetus due to maprotiline. There are, however, no adequate and well controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Maprotiline is excreted in breast milk. At steady-state, the concentrations in milk correspond closely to the concentrations in whole blood. Caution should be exercised when maprotiline hydrochloride is administered to a nursing woman.