Nortriptyline for treatment-resistant depression
by
Nierenberg AA, Papakostas GI, Petersen T, Kelly KE,
Iacoviello BM, Worthington JJ, Tedlow J, Alpert JE, Fava M.
Depression Clinical and Research Program,
Massachusetts General Hospital,
Harvard Medical School, Boston.
J Clin Psychiatry 2003 Jan;64(1):35-9

ABSTRACT

BACKGROUND: Up to 30% of patients with major depression fail to respond to an antidepressant trial, with most taking a selective serotonin reuptake inhibitor (SSRI) as initial treatment. While the tricyclic antidepressants might be effective for SSRI nonresponders, they have been relegated to third- and fourth-line treatment. This study assesses the efficacy of nortriptyline for patients with treatment-resistant major depression. METHOD: 92 patients with treatment-resistant DSM-III-R major depression, with resistance defined by at least 1, but no more than 5, well-documented adequate trials of antidepressants during the current episode, were treated openly with nortriptyline for 6 weeks. Patients were titrated up to full target doses of nortriptyline within 1 week, with target blood levels of 100 ng/mL. Response was defined as a 50% or greater decrease of baseline 17-item Hamilton Rating Scale for Depression score. We performed an intent-to-treat analysis with the last observation carried forward. RESULTS: Approximately 40% of patients were responders (N = 39) and 12% were remitters (N = 11) after 6 weeks of nortriptyline. Over a third of patients were unable to complete the trial. CONCLUSION: Nortriptyline was effective for over a third of patients with treatment-resistant depression, and nortriptyline should be considered as potential treatment if patients fail to respond to other antidepressants.

Options
Maprotiline
Imipramine
Dumb Drugs
Desipramine
Lofepramine
Amitriptyline
Nortriptyline
TCAs v SSRIs
Clomipramine
Norepinephrine
Antidepressant toxicity
Citalopram v nortriptyline
Nortriptyline (Aventyl) : structure

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