Acute open-trial nortriptyline therapy of bereavement-related depression in late life
Pasternak, R.E.; Reynolds, C.F.; Schlernitzauer, M.; Hoch, C.C.; Buysse, D.J.; Houck, P.R.; Perel, J.M.
Journal of Clinical Psychiatry 52(7): 307-310
1991
ISSN/ISBN: 0160-6689 PMID: 2071562 Document Number: 372809
Background: The aim of this study was to generate preliminary data on the clinical efficacy of nortriptyline in bereavement-related depression in late life. Method: Data are presented on 13 patients (5 men, 8 women), ranging in age from 61 to 78 years (mean = 71.1). Mean time from spousal loss to the beginning of treatment was 11.9 months (range, 2-25). Subjects were required to meet Research Diagnostic Criteria for syndromal current major depression and to have a stable Hamilton Rating Scale for Depression (HAM-D) score of .gtoreq. 15. Ten out of 13 volunteers were experiencing their first lifetime episode of major depression. Patients were treated with nortriptyline (mean dose = 49.2 mg/day; mean steady-state level = 68.1 ng/mL). Ratings performed at baseline and weekly during therapy were used to assess symptomatology, intensity of grief, level of functioning, social support, physical impairment, and medication side effects. Results: Pretreatment HAM-D ratings average 22.1 .+-. 3.6; posttreatment, 7.2 .+-. 2.8, representing a 67.9% decrease. All other rating scales showed significant clinical improvement, except the Texas Revised Inventory of Grief (a measure of grief intensity) (pretreatment, 51.4 .+-. 7.3; posttreatment, 46.6 .+-. 6.9, only a 9.3% decrease). Conclusions: These results suggest that nortriptyline is associated with significant symptomatic improvement in all areas of bereavement-related depression except continued intensity of grief after a median treatment interval of 6.4 weeks. This study indicates the need for a controlled clinical trial to determine the placebo response rate, the relapse rate after discontinuation of medication, and the value of combination therapy (using both pharmacotherapy and psychotherapy).