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August 10, 1979, Vol 242, No. 6 >
ARTICLE | August 10, 1979

Tricyclic Antidepressants

Alfred Coodley, MD, PhD
JAMA. 1979;242(6):511. doi:10.1001/jama.1979.03300060013005.
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ABSTRACT

To the Editor.—  I fully agree with Neal R. Cutler, MD, and Jon F. Heiser, MD (240:2264, 1978), in their article "The Tricyclic Antidepressants," except for one point regarding initial dosage. It has been my experience that one should start at a dosage equivalent to not more than 50 mg/day of imipramine hydrochloride. This is certainly true if 25 mg twice a day is administered, because a number of patients will become sedated and feel as if their depression has been intensified. Actually, I initiate therapy at 25 mg/day to make certain that side effects are absolutely minimal and also to give me a concrete idea as to how this particular patient relates to the taking of medication. After one to two days, I increase the dosage to 50 mg/day for one to two days and then raise it to the 75 mg/day that Cutler and Heiser recommended. The dosage

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