Nortriptyline for Treatment-Resistant Depression
J Clin Psychiatry 2003;64(1):35-39
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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
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.