A CRITICAL STUDY OF ISOCARBOXAZID (MARPLAN) IN THE TREATMENT OF DEPRESSED PATIENTS

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Abstract
Double-blind controlled studies of isocarboxazid vs. placebo were conducted simultaneously in 2 relatively similar state hospitals. In 1 hospital, all patients were assigned to a small research ward; in the other, patients were scattered over a number of admission wards. Significant positive drug-placebo differences were found in subjects treated on the research ward and were reflected by standard behavioral ratings of retardation and apathy and by personality inventory (MMPI) scores assessing depression, hysteria, and psychoticism. The percentage of patients (drug and placebo groups combined) showing some degree of improvement after being treated on a small research ward was significantly higher than it was for those treated in the general hospital population. This observation reflected, in part, the fact that 54% of placebo-treated psychotic depressed patients became worse in the setting of general admission buildings, while only 10% became worse in the research ward milieu. Results of this investigation might help to explain the frequently conflicting reports of drug efficacy which are based on studies carried out in varied settings. The fact that maximum improvement was achieved by patients who received drug treatment in the setting of a small research ward suggests that depressed inpatients might be more effectively treated as a homogeneous group in the setting of a small, relatively intimate ward-.