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

Research output: Contribution to journalArticle

53 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)35-39
Number of pages5
JournalJournal of Clinical Psychiatry
Volume64
Issue number1
StatePublished - Jan 1 2003
Externally publishedYes

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Treatment-Resistant Depressive Disorder
Nortriptyline
Antidepressive Agents
Serotonin Uptake Inhibitors
Depression
Tricyclic Antidepressive Agents
Therapeutics
Diagnostic and Statistical Manual of Mental Disorders
Observation

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Nierenberg, A. A., Papakostas, G. I., Petersen, T., Kelly, K. E., Iacoviello, B. M., Worthington, J. J., ... Fava, M. (2003). Nortriptyline for treatment-resistant depression. Journal of Clinical Psychiatry, 64(1), 35-39.

Nortriptyline for treatment-resistant depression. / Nierenberg, Andrew A.; Papakostas, George I.; Petersen, Timothy; Kelly, Karen E.; Iacoviello, Brian M.; Worthington, John J.; Tedlow, Joyce; Alpert, Jonathan E.; Fava, Maurizio.

In: Journal of Clinical Psychiatry, Vol. 64, No. 1, 01.01.2003, p. 35-39.

Research output: Contribution to journalArticle

Nierenberg, AA, Papakostas, GI, Petersen, T, Kelly, KE, Iacoviello, BM, Worthington, JJ, Tedlow, J, Alpert, JE & Fava, M 2003, 'Nortriptyline for treatment-resistant depression', Journal of Clinical Psychiatry, vol. 64, no. 1, pp. 35-39.
Nierenberg AA, Papakostas GI, Petersen T, Kelly KE, Iacoviello BM, Worthington JJ et al. Nortriptyline for treatment-resistant depression. Journal of Clinical Psychiatry. 2003 Jan 1;64(1):35-39.
Nierenberg, Andrew A. ; Papakostas, George I. ; Petersen, Timothy ; Kelly, Karen E. ; Iacoviello, Brian M. ; Worthington, John J. ; Tedlow, Joyce ; Alpert, Jonathan E. ; Fava, Maurizio. / Nortriptyline for treatment-resistant depression. In: Journal of Clinical Psychiatry. 2003 ; Vol. 64, No. 1. pp. 35-39.
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