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Nortriptyline for treatment-resistant depression.

Andrew A Nierenberg·George I Papakostas·Timothy Petersen·Karen E Kelly·Brian M Iacoviello·John J Worthington·Joyce Tedlow·Jonathan E Alpert·Maurizio Fava
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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.

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AdolescentAdultAgedAmbulatory CareAntidepressive AgentsAntidepressive Agents, Second-GenerationAntidepressive Agents, TricyclicDepressive DisorderDrug Administration ScheduleDrug ResistanceFemaleHumansMaleMiddle AgedNortriptylinePsychiatric Status Rating ScalesRetrospective StudiesSelective Serotonin Reuptake InhibitorsTreatment OutcomeClinical TrialComparative StudyJournal ArticleResearch Support, U.S. Gov't, P.H.S.

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Andrew A Nierenberg, George I Papakostas, Timothy Petersen, Karen E Kelly, Brian M Iacoviello, John J Worthington, Joyce Tedlow, Jonathan E Alpert, Maurizio Fava. 2003. Nortriptyline for treatment-resistant depression.. https://doi.org/10.4088/jcp.v64n0108

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