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Original Research

Nortriptyline for Treatment-Resistant Depression

Andrew A. Nierenberg, MD; George I. Papakostas, MD; Timothy Petersen, PhD; Karen E. Kelly, BA; Brian M. Iacoviello, BA; John J. Worthington, MD; Joyce Tedlow, MD; Jonathan E. Alpert, MD; PhD; and Maurizio Fava, MD

Published: January 15, 2003

Article 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.

Volume: 64

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