Involutional melancholia

Nortriptyline appeared to be somewhat more consistently effective than the other agents, except in involutional melancholia. Particularly impressive was the improvement rate in the manic depressive group (87% vs. 69% for the others). Side effects were generally mild, although dryness of the mouth occurred in 52% of the patients. Somnolence occurred in only 8% of the patients and, as with desipramine, the secondary amine congener appeared to be less of a central depressant. Onset of action was fairly prompt. Initial improvement occurred after 7 to 10 days. 

The mean GSH index in psychotic patients (schizophrenia, manic-depressive psychosis, and involutional melancholia) ranges from 25 to 35 mg. per 100 cc. packed RBC (standard deviation 6.1) and the mean normal GSH index ranges from 63 to 93 mg. per 100 cc. packed RBC (standard deviation 11.3) as determined by six (56-61) groups of investigators during the past twenty years. Insulin and electric shock therapy raise the GSH content of the blood in these patients (61-63). 

In Western terms, Lisa s pattern of symptoms is fairly typical of a classic form of depression previously known as melancholia or involutional depression. On a chemical level, it s the result of insufficient norepinephrine and dopamine, the chemicals used to stimulate our brains. With depleted reserves of these crucial neurotransmitters, we find it difficult to remain awake, alert, and stimulated. As a result, we fall into the condition that fits the stereotyped view of depression so tired and weighed down that it s literally difficult to get out of bed. 

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