Psychiatric Comorbidity as a Predictor of Clinical Response to Nortriptyline in Treatment-Resistant Major Depressive Disorder
J Clin Psychiatry 2003;64:1357-1361
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: A number of studies of major
depressive disorder suggest that psychiatric comorbidity may
contribute to treatment resistance. The purpose of this study was
to test whether the presence of comorbid Axis I and Axis II
disorders predicts clinical response to an open trial of
nortriptyline among patients with treatment-resistant depression.
Method: Ninety-two outpatients with
treatment-resistant DSM-III-R major depressive disorder were
enrolled in a 6-week open trial of nortriptyline (Nov. 1992-Jan.
1999). The presence of comorbid Axis I and Axis II disorders was
established at baseline with the use of the Structured Clinical
Interview for DSM-III-R. Chi-square analyses were used to test
Axis I or Axis II comorbid conditions as a predictor of clinical
response to nortriptyline.
Results: Thirty-nine patients (42.4%) responded
to nortriptyline. The presence of avoidant personality disorder
(p < .01) predicted poorer response to nortriptyline. The
response rate was 16.7% for patients with and 48.6% for patients
without comorbid avoidant personality disorder. No other comorbid
diagnoses were found to predict clinical response in a
statistically significant manner.
Conclusion: The presence of avoidant personality
disorder conferred a poorer prognosis in treatment-resistant
depression patients treated with nortriptyline.