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Nortriptyline Effective In One-Third Of Treatment-Resistant Depression Patients

Nortriptyline is effective in more than one-third of patients with treatment-resistant major depression, research in the United States indicates.

The drug should be considered in treatment-resistant depression patients who fail to respond to therapy with other antidepressants, say researchers from Massachusetts General Hospital and Harvard Medical School in Boston.

They explain that up to 30% of major depression patients fail to respond to an antidepressant trial. Most patients take a selective serotonin reuptake inhibitor (SSRI) as the initial drug. Tricyclic antidepressants could be effective for patients failing to respond to an SSRI, but those drugs have been relegated to third- and fourth-line therapy.

The efficacy of nortriptyline was assessed in 92 patients with treatment-resistant major depression. Participants were diagnosed using Diagnostic & Statistical Manual for Mental Disorders-III-Revised criteria. All were resistant to at least one but no more than five antidepressants during that depressive episode.

Participants were treated openly with nortriptyline for six weeks, titrated up to full target doses within one week. Target blood levels were 100 ng/mL. The definition of response was a 50% or greater decrease in baseline score on the 17-item Hamilton Rating Scale for Depression.

Results indicate approximately 40% (39 patients) responded to nortriptyline, with 12% (11 patients) remitting after six weeks of therapy.

The researchers also point out that more than one-third of participants were unable to complete the trial.
Journal of Clinical Psychiatry Jan 2003;64:35-39. "Nortriptyline for treatment-resistant depression."

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