Psychiatric Comorbidity as a Predictor of Clinical Response to Nortriptyline in Treatment-Resistant Major Depressive Disorder

George I. Papakostas, Timothy J. Petersen, Amy H. Farabaugh, Jessica L. Murakami, Joel A. Pava, Jonathan E. Alpert, Maurizio Fava, Andrew A. Nierenberg

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1357-1361
Number of pages5
JournalJournal of Clinical Psychiatry
Volume64
Issue number11
DOIs
StatePublished - Nov 2003
Externally publishedYes

ASJC Scopus subject areas

  • Psychiatry and Mental health

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    Papakostas, G. I., Petersen, T. J., Farabaugh, A. H., Murakami, J. L., Pava, J. A., Alpert, J. E., Fava, M., & Nierenberg, A. A. (2003). Psychiatric Comorbidity as a Predictor of Clinical Response to Nortriptyline in Treatment-Resistant Major Depressive Disorder. Journal of Clinical Psychiatry, 64(11), 1357-1361. https://doi.org/10.4088/JCP.v64n1112